Understanding advance care planning in care homes throughout the COVID-19 pandemic: A critical realist review and synthesis

Abstract

Background: The COVID-19 pandemic has disrupted advance care planning discussions in care homes, particularly discussions involving relatives and surrogate decision makers. There is a need to collate and examine current evidence to assess the extent of the problem. Aim: To examine the processes and experiences involved in advance care planning in care homes throughout the COVID-19 pandemic. Design: A critical realist review and synthesis. Data Sources: MEDLINE, psycINFO, SCOPUS and CINAHL were searched between December 2019 and May 2022. Results: Eleven studies were included. Communication difficulties associated with remote technologies meant that care home staff’s concerns about engaging effectively with relatives further exacerbated the emotional toll of dealing with high death rates in circumstances where staff shortages stretched the capacity of those remaining to provide timely advance care planning discussions. The threat of the pandemic tended to encourage earlier and more frequent advance care planning discussions, though this tendency was partially countervailed by the difficulties that some residents and relatives had in engaging with remote communication modes. There was evidence that education and training in advance care planning increased staff’s confidence and readiness to engage in care planning during pandemic conditions. Conclusion: Results highlight part of the new context facing staff, relatives and residents in care homes, thus providing valuable insight for future intervention development required to maintain and improve the effectiveness of advance care planning in care homes during and beyond the pandemic.

Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews

“…Following the screening process, 58 of the 674 identified studies were considered for inclusion, and subsequently, a further 51 studies were excluded because they were not related to ACP,19–56 not review articles57–64 and encompassed pre-pandemic studies 65–69. Finally, we included seven studies—two systematic reviews,70 71 three scoping reviews,7 72 73 one narrative review74 and one critical realist review 75…”

“…Ideally, ACP information obtained at each facility should be included in a system that is accessible to health professionals across settings 8. During the pandemic, telemedicine began to be, promoted in clinics providing home visit services and in underpopulated areas owing to infrastructural advancements and progress in legislation,83 and its use has the potential to facilitate ACP discussions 75. However, funding for information-sharing systems and telemedicine capability is required in hospitals and facilities that do not have the appropriate infrastructure; therefore, the government should incorporate telemedicine into its policies to ensure that it is both carried out and receives sustainable support.…”

Barriers to and facilitators of advance care planning implementation for medical staff after the coronavirus disease 2019 pandemic: An overview of reviews

“…Ideally, advance care planning information obtained at each facility should be included in a system that is accessible to other health professionals (8). During the pandemic, telemedicine began being promoted in clinics providing home visit services and in underpopulated areas owing to infrastructural advancements and progress in legislation (58), and its use has the potential to facilitate advance care planning discussions (50). However, funding for information-sharing systems and telemedicine capability is required in hospitals and facilities that do not have the appropriate infrastructure; therefore, the government should incorporate telemedicine into its policies to ensure that it is both implemented and receives sustainable support.…”

A protocol for a systematic critical realist synthesis of school mindfulness interventions designed to promote pupils’ mental wellbeing

“…Instead, they argue that there are demi-regularities, and it is how they occur that needs to be explained; that is why an intervention works in some contexts and not others and for some people and not others (52). Critical realism is theory-driven and seeks to explain/theorise why things occur in the way they do, what the (generally hidden) mechanisms are that generate events, recognise that social systems are open, eliminated and layered and that events are often the outcome of the complex interaction of mechanisms (75,(77)(78)(79)(80). The effectiveness of an intervention is not based only on its inherent qualities but on the action of agents in taking up the opportunities afforded by the intervention to trigger mechanisms that result in the outcomes (60,71).…”