Better advance care planning in long-term care through starting the conversation

Capps, Christina; EdD, C. Fred Capps; Gillen, Lynda J; Hayley, Déon Cox; Mason, Russ

doi:10.1016/j.jamda.2017.12.049

Cited by 5 publications

(4 citation statements)

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“…advance directives). Current ACP research in LTC affirms the high prevalence of medically-focused ACP materials, as most studies exploring ACP impacts in LTC actually look more specifically at the implementation of advance medical directives [ 49 ]. While outcomes from this work have certainly shown some promise, our findings suggest such interventions are unlikely to be successfully adopted into usual practice in LTC if psychosocial issues are excluded, such as preferences for family involvement/non-involvement in EOL care, views about dying alone, spiritual beliefs that may provide comfort at EOL, and values related to quality of life/quality of care [ 34 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Exploration of the acceptability and usability of advance care planning tools in long term care homes

et al. 2020

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Objectives Despite known benefits, advance care planning (ACP) is rarely a component of usual practice in long-term care (LTC). A series of tools and workbooks have been developed to support ACP uptake amongst the generable population. Yet, their potential for improving ACP uptake in LTC has yet to be examined. This study explored if available ACP tools are acceptable for use in LTC by (a) eliciting staff views on the content and format that would support ACP tool usability in LTC (b) examining if publicly available ACP tools include content identified as relevant by LTC home staff. Ultimately this study aimed to identify the potential for existing ACP tools to improve ACP engagement in LTC. Methods A combination of focus group deliberations with LTC home staff (N = 32) and content analysis of publicly available ACP tools (N = 32) were used to meet the study aims. Results Focus group deliberations suggested that publicly available ACP tools may be acceptable for use in LTC if the tools include psychosocial elements and paper-based versions exist. Content analysis of available paper-based tools revealed that only a handful of ACP tools (32/611, 5%) include psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%). Conclusions ACP tools that include psychosocial content may improve ACP uptake in LTC because they elicit future care issues considered pertinent and can be supported by a range of clinical and non-clinical staff. To increase usability and engagement ACP tools may require infusion of scenarios pertinent to frail older persons, and a better balance between psychosocial content that elicits reflections and psychosocial content that supports communication.

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Section: Discussionmentioning

confidence: 99%

Exploration of the acceptability and usability of advance care planning tools in long term care homes

et al. 2020

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“…While COVID-19 may have been the initial motivator to ensure these conversations were had earlier rather than later, it should not end there. Structures and processes to facilitate initial and ongoing conversations around ACP and GoC should become best practice for LTC homes [23]. While COVID-19 necessitated much of the work done, this upstream work is not only relevant to the environment of COVID-19, but an important practice reflected in a palliative approach embedded into the philosophy of LTC homes.…”

Section: Discussionmentioning

confidence: 99%

Perspectives across Canada about implementing a palliative approach in long-term care during COVID-19

et al. 2023

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Background Long-term care (LTC) homes have been disproportionately impacted during COVID-19. Purpose To explore the perspectives of stakeholders across Canada around implementing a palliative approach in LTC home during COVID-19. Methods Qualitative, descriptive design using one-to-one or paired semi-structured interviews. Results Four themes were identified: (1) the influence of the pandemic on implementing a palliative approach, (2) families are an essential part of implementing a palliative approach, (3) prioritizing advance care planning (ACP) and goals of care (GoC) discussions in anticipation of the overload of deaths and (4) COVID-19 highlighting the need for a palliative approach as well as several subthemes. Conclusion The COVID-19 pandemic influenced the implementation of a palliative approach to care, where many LTC homes faced an overwhelming number of deaths and restricted the presence of family members. A more concentrated focus on home-wide ACP and GoC conversations and the need for a palliative approach to care in LTC were identified.

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“…With the potential to bridge incongruencies between the residents' wishes and the care they actually receive, it is essential that LTCH staff incorporate a palliative approach to care that integrates ACP for residents [14]. Patient-provider ACP communication has been shown to improve the patient experience, align treatment with patients' preferences, avoid unwanted and costly invasive treatments near EOL, and improve psychological outcomes for family members related to proxy decision making and during bereavement [7,[15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary staff perceptions of advance care planning in long-term care homes: a qualitative study

et al. 2022

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Background Residents living in long-term care homes (LTCH) have complex care needs, multiple chronic conditions, increasing frailty and cognitive impairment. A palliative approach that incorporates advance care planning (ACP) should be integrated with chronic disease management, yet it is not a norm in most LTCHs. Despite its growing need, there remains a lack of staff engagement in the ACP process. Objectives The aim of this study was to explore the perceptions and experiences of interdisciplinary staff related to the practice of ACP in LTCHs. Methods This study is part of a larger Canadian project, iCAN ACP, that aims to increase uptake, and access to ACP for older Canadians living with frailty. An exploratory qualitative design using an interpretive descriptive approach was employed utilizing focus groups and semi-structured interviews with staff from four LTCHs in Ontario, Canada. Findings There were 98 participants, including nurses (n = 36), physicians (n = 4), personal support workers (n = 34), support staff (n = 23), and a public guardian (n = 1). Three common themes and nine subthemes were derived: a) ongoing nature of ACP; b) complexities around ACP conversations; and c) aspirations for ACP becoming a standard of care in LTCHs. Discussion The findings of this study provide important contributions to our understanding of the complexities surrounding ACP implementation as a standard of practice in LTCHs. One of the critical findings relates to a lack of ACP conversations prior to admission in the LTCHs, by which time many residents may have already lost cognitive abilities to engage in these discussions. The hierarchical nature of LTCH staffing also serves as a barrier to the interdisciplinary collaboration required for a successful implementation of ACP initiatives. Participants within our study expressed support for ACP communication and the need for open lines of formal and informal interdisciplinary communication. There is a need for revitalizing care in LTCHs through interdisciplinary care practices, clarification of role descriptions, optimized staffing, capacity building of each category of staff and commitment from the LTCH leadership for such care. Conclusion The findings build on a growing body of research illustrating the need to improve staff engagement in ACP communication in LTCHs.

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Better advance care planning in long-term care through starting the conversation

Cited by 5 publications

References 0 publications

Exploration of the acceptability and usability of advance care planning tools in long term care homes

Exploration of the acceptability and usability of advance care planning tools in long term care homes

Perspectives across Canada about implementing a palliative approach in long-term care during COVID-19

Interdisciplinary staff perceptions of advance care planning in long-term care homes: a qualitative study

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