Facilitators and barriers to advance care planning implementation in Australian aged care settings: A systematic review and thematic analysis

Abstract

Objectives There are many studies investigating implementation of advance care planning (ACP) in aged care around the world, but few studies have investigated Australian settings. The objective of this study was to determine facilitators and barriers to implementation of ACP in Australian residential and community aged care. Methods Evidence from Australian studies published between 2007 and September 2017 of ACP in residential and community aged care was sourced from electronic databases using predetermined search strategies. Data were extracted and synthesised using thematic analysis, and summarised according to themes. Results Nine studies described facilitators and barriers of ACP implementation. Six themes were identified: “Education and Knowledge,” “Skills and Training,” “Procedures and Resources,” “Perceptions and Culture,” “Legislation” and “Systems.” Conclusions A whole of systems approach is necessary to facilitate uptake of ACP in residential aged care settings. More research is needed to understand facilitators and barriers to ACP in community aged care.

Reducing the use of physical restraints in home care - Development and feasibility testing of a multicomponent program to support the implementation of a guideline

“…In addition, the ambassadors felt that they did not have the organizational power to carry out this change project within their organization. Earlier studies show that the absence of staff with the right competences or expertise impedes implementation (20,39,40,(42)(43)(44)(45)(46)(47)(48). For this reason, the research group formulated desirable competences (e.g.…”

Wishes and needs of nursing home residents and their relatives regarding end‐of‐life decision‐making and care planning—A qualitative study

“…This is usually done through a dialogical and long‐term conversation process (Musa, Seymour, Narayanasamy, Wada, & Conroy, 2015). Depending on the concept, trusted persons in the social environment and care context of those affected are included in the communication process (Batchelor et al., 2019; Gilissen et al., 2019; Hickman et al., 2019). The implementation of ACP reflects, above all, well‐established, institutionalised routines of conduct that hinder decision‐making processes at the end of life and enhances competence among professional actors in the use of advance planning documentation (Cornally et al., 2015; Flo et al., 2016; Stewart, Goddard, Schiff, & Hall, 2011).…”

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“…Even if organisational barriers are low, ACP is not inquired as frequently as expected because of cultural and psychological barriers that hinder a frequent realization of ACP and communications about EoL wishes. Those barriers include fear of own death and of burdening relatives, unawareness of gravity of disease, "optimism", aversive emotional responses to reflecting death and avoidance of end-of-life topics [7,8,18,19].…”

“…A recent systematic review stated that multi-focal interventions may effectively remove barriers to end-of-life communication [16]. Such multifocal interventions may include amongst others a) facilitation of communication by specifically trained personnel, b) advance care planning, c) structured communication roles, responsibilities and processes, d) summarising patient end-of-life preferences and values using a questionnaire with feedback of this summary document to clinicians and e) psychoeducation for patients and relatives [16,19,20].…”