Experience of use of Advance Care Planning in care homes

Holman, Deborah; Sawkins, Nikki; Hockley, Jo

doi:10.1093/acprof:oso/9780199561636.003.0012

Cited by 4 publications

(5 citation statements)

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“…Although forms of ACP have been prevalent in the United States of America (USA) for nearly 20 years (Wilkinson 2011), it is a relatively recent healthcare innovation in other countries such as Australia, the United Kingdom (UK) and Canada (Parker et al 2007, Henry & Joseph 2011, Holman et al 2011, Mason et al 2011, Nielson & Baxter 2011. However, the effectiveness of a whole-system approach (Lynn et al 2000) is demonstrated in national initiatives to improve end of life care, such as the Gold Standards Framework (GSF) in the UK (Shaw et al 2010, Phillips et al 2011 and palliative care and hospice standards and models introduced in Australia, the USA and Canada (Ferris et al 2002, Connor et al 2004, NHPCO 2010.…”

Section: Introductionmentioning

confidence: 99%

Is an advance care planning model feasible in community palliative care? A multi‐site action research approach

Blackford

Street

2011

Journal of Advanced Nursing

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Section: Introductionmentioning

confidence: 99%

Is an advance care planning model feasible in community palliative care? A multi‐site action research approach

Blackford

Street

2011

Journal of Advanced Nursing

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“…Further incentive for ACP relates to preferred place of death, with figures highlighting that despite around two thirds of people wishing to die at home, less than a third actually do (Higginson and Sen-Cupta, 2004). This issue was explored by Holman et al (2011), who discussed the difficulties that care home staff face when residents with dementia are admitted to hospital in the last few days of life owing to a lack of formal documentation, particularly relating to resuscitation status.…”

Section: Why Advance Care Planning?mentioning

confidence: 99%

Advance care planning for people with dementia: benefits and challenges

Dempsey

2013

Int J Palliat Nurs

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Advance care planning (ACP) is a process being championed within health and social care, particularly since the publication of the UK Department of Health's 2008 End of Life Care Strategy. However, its implementation in dementia care is yet to be fully realised and can pose significant ethical and legal dilemmas for the generic and specialist workforce, the patient themselves, and their family or loved ones. Challenges may be attributable to inadequate communication, capacity issues, missed opportunities, and the perception that dementia is not a life-limiting illness. The aim of this paper is to highlight the benefits of ACP for individuals with dementia while appraising the recognised barriers to assist in developing some realistic recommendations for future practice.

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“…For those advanced cancer or endstage organ failure patients opted for conservative care, this will make sure that their expectations for EOL care can be respected. Professionals cared for these medically ill patients can be difficult to ascertain their wishes and preferences especially for those without family (9). There could be a chance that their clinicians are not willing to make advanced decisions, thus conflicts among different parties might arise.…”

Section: Introductionmentioning

confidence: 99%

“…There could be a chance that their clinicians are not willing to make advanced decisions, thus conflicts among different parties might arise. According to literatures, most medical staff are well aware of the unnecessary conflicts and invasive interventions in hospital setting when these patients reach EOL and become confused, distressed and powerless in the last 48 hours of life because there is a lack of documentation of his/her wishes, expectations or resuscitation status (9). One randomized controlled trial demonstrated that patients in the ACP group had higher likelihood of EOL wishes being known and followed, and their family members also reported less anxious or depressed (10).…”

Section: Introductionmentioning

confidence: 99%

Impact of structured advance care planning program on patients’ wish items and healthcare utilization

Chan¹,

Chiu²,

Yap³

et al. 2021

Ann Palliat Med

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Background: Structured advance care planning (ACP) program is an important service in the end-of-life care for patients with advanced medical illness. We pioneered a structured and coordinated ACP program for patients with advanced malignancies and end-stage organ failure in Hong Kong. This study investigated the impact of a structured ACP program on the concordance rate for patients' final wishes, patient/family satisfaction, and the number of acute admissions (AA) and length of stay (LOS) in hospital.Methods: Patients with advanced malignancy or end-stage organ failure who were able to complete ACP forms during the current admission to medical units were recruited. Patients who could not complete ACP forms or <18 years of age were excluded. The ACP program comprised the following components: (I) baseline education (workshop/role play) in ACP sessions for linked nurses of different medical units; (II) structured ACP discussions with recruited patients and their proxies during admission, after any change in clinical status, and also at monthly intervals; (III) formal structured review of patients' goals at regular team meetings; (IV) "flagging" of advance directive (AD) in hospital computer system and (V) feedback to linked nurse on the congruence of care. Mentally competent patients who did not receive ACP and matched for disease and demographics were selected as controls in a 1:2.5 ratio.Results: Two hundred forty-three patients were included for analysis between August 2016 and July 2017, of which 69 patients joined the ACP program and 174 of them did not. Two hundred and one patients (83%) had advanced cancer. All had done do-not-attempt-cardiopulmonary-resuscitation (DNACPR) order in the ACP group. The concordance rates for patients' wishes on quality of life, end-of-life and funeral arrangements were 95%, 100% and 100% respectively. Over 70% of patients and their families (N=10) showed satisfaction with the program. The ACP group also had lower mean AA and shorter LOS (0.78±0.23 vs. 1.2±0.8 episode/patient, 4.6±1.7 vs. 7.5±2.5 days, P=0.037 and P=0.023 respectively) in the last 3 months of life compared with the non-ACP group.Conclusions: This ACP program achieved high concordance rate for patients' wish items and reduced healthcare utilization.

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Experience of use of Advance Care Planning in care homes

Cited by 4 publications

References 0 publications

Is an advance care planning model feasible in community palliative care? A multi‐site action research approach

Is an advance care planning model feasible in community palliative care? A multi‐site action research approach

Advance care planning for people with dementia: benefits and challenges

Impact of structured advance care planning program on patients’ wish items and healthcare utilization

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