Acceptability of a nurse-led, person-centred, anticipatory care planning intervention for older people at risk of functional decline: A qualitative study

Abstract

Background As the population of older adults increases, the complexity of care required to support those who choose to remain in the community amplifies. Anticipatory Care Planning (ACP), through earlier identification of healthcare needs, is evidenced to improve quality of life, decrease aggressive interventions, and prolong life. With patient acceptability of growing importance in the design, implementation, and evaluation of healthcare interventions, this study reports on the acceptability of a primary care based ACP intervention on the island of Ireland. Methods As part of the evaluation of a feasibility cluster randomized controlled trial (cRCT) testing an ACP intervention for older people at risk of functional decline, intervention participants [n = 34] were interviewed in their homes at 10-week follow-up to determine acceptability. The intervention consisted of home visits by specifically trained registered nurses who assessed participants’ health, discussed their health goals and plans, and devised an anticipatory care plan in collaboration with participants’ GPs and adjunct clinical pharmacist. Thematic analysis was employed to analyze interview data. The feasibility cRCT involved eight general practitioner (GP) practices as cluster sites, stratified by jurisdiction, four in Northern Ireland (NI) (two intervention, two control), and four in the Republic of Ireland (ROI) (two intervention, two control). Participants were assessed for risk of functional decline. A total of 34 patients received the intervention and 31 received usual care. Findings Thematic analysis resulted in five main themes: timing of intervention, understanding of ACP, personality & individual differences, loneliness & social isolation, and views on healthcare provision. These map across the Four Factor Model of Acceptability (‘4FMA’), a newly developed conceptual framework comprising four components: intervention factors, personal factors, social support factors, and healthcare provision factors. Conclusion Acceptability of this primary care based ACP intervention was high, with nurses’ home visits, GP anchorage, multidisciplinary working, personalized approach, and active listening regarded as beneficial. Appropriate timing, and patient health education emerged as vital.

Anticipatory care planning for community-dwelling older adults at risk of functional decline: a feasibility cluster randomized controlled trial

“…Thirty-four patients (RoI = 19, NI = 15) from the ACP intervention group completed qualitative interviews at 10 weeks. The results of these interviews are reported in more detail in another paper and are summarised here [ 37 ]. Patients interviewed reported unanimous acceptance of the ACP intervention, as well as its individual components.…”

“…The template analysis style, outlined previously [ 36 ], was used for analysis, with themes, patterns, and interrelationships identified and interpreted, leading to a theme structure and final thematic framework. More detail on qualitative analyses is available elsewhere [ 37 , 38 ].…”

“Making an effort for the very elderly”: The acceptability of a multidisciplinary intervention to retirement village residents

“…These results share similarities with other research in this area. Corry et al ( 2021 ) assessed the acceptability of a pilot study of nurse‐led MD anticipatory care planning embedded within primary care where specialist nurses conducted several home visits over a 10‐week period. Similar to our study, home visits were well received, with participants feeling at ease and relaxed in their own environments and appreciated the person‐centred communication and emotional support.…”

Successful implementation of a trans-jurisdictional, primary care, anticipatory care planning intervention for older adults at risk of functional decline: interviews with key health professionals

“…The ACP protocol has been described in detail elsewhere [ 16 ]. We interviewed patients about the acceptability of the intervention [ 18 ] and implementing stakeholders (i.e., GPs, practice managers, pharmacist, research nurses) about their experience with testing the feasibility of the intervention (under review). The aim of this paper is to report on the expert views of non-participating key health professionals (KHP)s (see Table 2 for occupations) about the benefits and limitations of the intervention, and systemic barriers and facilitators to its’ implementation and sustainability.…”