Facilitators and barriers to advance care planning programmes targeting older care home residents: a qualitative study

Lau, Billy T.; Luk, James Ka-Hay; Fong, Candy H. C.; Chow, Amy Y. M.; Chan, Cecilia L. W.; Ng, Wing Chun; Chan, Wen‐Hsiung; Chan, Felix Hon Wai

doi:10.12809/ajgg-2018-326-oa

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…With an ageing population in Hong Kong, it is desirable to promote advance care planning and advance directives in older people so that their healthcare wishes are better understood. 20 CHF was safe in suitable patients with dysphagia; only 6% had pneumonia after CHF. This is comparable to a study in Singapore that reported a rate of aspiration pneumonia of 7.7% in patients with dysphagia who refused nasogastric tube feeding and had oral feeding.…”

Section: Discussionmentioning

confidence: 84%

Careful hand feeding in a geriatric step-down hospital: a retrospective study

Luk¹,

Lin²,

Chan³

2022

Asian Journal of Gerontology and Geriatrics

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Objective. To evaluate the safety and effectiveness of the careful hand feeding (CHF) programme in a geriatric step-down hospital.Methods. Medical records of patients aged ≥65 years who received CHF in Fung Yiu King Hospital between February 2017 and November 2021 were retrospectively reviewed.Results. 446 patients (178 men and 268 women) aged 66 to 109 (mean, 91) years were included for analysis. 88% of patients were severely frail or very severely frail. 70% of patients had advanced dementia. 81.3% of patients had dysphagia. 44% of patients were in imminent death status (who were highly likely to die within a week) before starting CHF. Food intake during CHF was poor or very poor in 51% of patients and satisfactory or good in 49% of patients. 90% of patients required clinically assisted hydration. The mean length of hospital stay was 19.3±16 days, and the mean duration of CHF was 14±13.5 days. 39% of patients died during the index admission; most of the remaining 61% of patients were discharged to their original placement. 27 (6%) patients had pneumonia. Independent predictors for pneumonia were the length of hospital stay (odds ratio=1.024, p=0.014) and poor/very poor intake (odds ratio=1.82, p=0.017). Conclusion.CHF is safe in a geriatric step-down hospital and avoids use of a nasogastric feeding tube in patients in their last phase of life. It fosters comfort and dignity for dying patients. Most patients can return to their original placement for CHF after discharge.

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Section: Discussionmentioning

confidence: 84%

Careful hand feeding in a geriatric step-down hospital: a retrospective study

Luk¹,

Lin²,

Chan³

2022

Asian Journal of Gerontology and Geriatrics

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“…There is growing evidence of the potential effectiveness of advance care planning in nursing homes (42)(43)(44)(45). Relatives have been identi ed as one of ve key facilitators of this process.…”

Section: Discussionmentioning

confidence: 99%

Nurses’ Perspectives on the Role of Relatives in Emergency Situations in Nursing Homes: a Qualitative Study From Germany

Schwabe

Bleidorn

Günther

et al. 2022

Preprint

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Background: In nursing homes, emergencies often result in unnecessary hospital transfers, which may negatively affect residents’ health. Emergency management in nursing homes is complicated by structural conditions, uncertainties and difficulties communicating with the treating healthcare professionals. The present study investigated the role played by relatives in this emergency management, as perceived by nursing staff.Methods: Within the context of a larger multi-method, interdisciplinary research project, we conducted six focus group discussions and 33 semi-structured interviews with nurses at nursing homes in northern Germany between September 2020 and April 2021. Discussions and interviews focused on emergency management in nursing homes, and were recorded, transcribed and analysed using qualitative content analysis, according to Mayring.Results: Nurses reported that relatives were actively involved in emergency management in the nursing homes. Relatives were informed when there was an emergency situation, and they participated in decision making around the resident’s care. Nurses sometimes perceived the involvement of relatives as challenging, due to a lack of time or staff, the opposing views of relatives and/or uncertain communication structures; however, they were willing to involve relatives according to the relatives’ preferences. The role played by relatives was seen to range from that of an active supporter to that of a troublemaker. On the one hand, relatives were reported to support nurses in emergency management (i.e. by identifying residents’ preferences and advocating for residents’ interests). On the other hand, relatives were often perceived by the nurses as overstrained and unprepared in emergency situations, leading them to override residents’ wishes, question the emergency plan and put pressure on the nurses’ decision making.Conclusions: Nurses perceive the roles played by relatives in emergency situations in nursing homes as relatively supportive or, alternatively, demanding and troublesome. The timely involvement of relatives in emergency planning, the establishment of clear agreements with general practitioners and the development of trusting relationships between nursing staff and relatives may improve emergency management for nurses.

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“…Emotional support, reassurance, and space for sharing personal feelings provided within terminal care interventions are valued by patients at EoL and their families. [31][32][33] It could also imply that as patients became more at peace with impending death, their mood improved, and their physical distress decreased.…”

Section: Reported Outcomes Of Changes In Symptomsmentioning

confidence: 99%

The Physical and Psychosocial Outcomes of a Psychosocial Home-Based end-of-Life Care Intervention in Hong Kong

et al. 2023

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Objective Living the final days of life being cared for at home is a preference expressed by many. The data on the effectiveness of home-based end-of-life care (EoLC) intervention to improve the holistic conditions of terminally ill patients are scanty. This study sought to evaluate a psychosocial home-based EoLC intervention for terminally ill patients in Hong Kong. Methods A prospective cohort study was conducted, applying the Integrated Palliative Care Outcome Scale (IPOS) at 3 timepoints (service intake, 1-month, and 3-months after enrollment). A total of 485 eligible, consenting terminally ill people (mean age = 75.48, SD = 11.39) were enrolled, with 40.21% (n = 195) providing data at all 3 timepoints for this study. Results Decreasing symptom severity scores were observed for all IPOS psychosocial symptoms, and most physical symptoms, over the 3 timepoints. Improvements in depression and practical concerns had the highest omnibus time effects ( F > 31.92, P < .01) and T0 to T2 paired comparison effects ( Cohen's d > 0.54, P < .01). Physical symptoms of weakness/lack of energy, poor mobility, and poor appetite also showed significant improvements at T1 and T2 ( Cohen's d: 0.22-0.46, P < .05). Bivariate regression analyses showed that improvements in anxiety, depression, and family anxiety were associated with improvements in physical symptoms of pain, shortness of breath, weakness/lack of energy, nausea, poor appetite, and poor mobility. Patients’ demographic and clinical characteristics were not associated with changes in symptoms. Conclusions The psychosocial home-based EoLC intervention effectively improved the psychosocial and physical status of terminally ill patients, irrespective of their clinical characteristics or demographics.

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Facilitators and barriers to advance care planning programmes targeting older care home residents: a qualitative study

Cited by 7 publications

References 14 publications

Careful hand feeding in a geriatric step-down hospital: a retrospective study

Careful hand feeding in a geriatric step-down hospital: a retrospective study

Nurses’ Perspectives on the Role of Relatives in Emergency Situations in Nursing Homes: a Qualitative Study From Germany

The Physical and Psychosocial Outcomes of a Psychosocial Home-Based end-of-Life Care Intervention in Hong Kong

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