Improving person-centered advance care planning conversation with older          people: a qualitative study of core components perceived by healthcare          professionals

Muraya, Tsukasa; Akagawa, Yuko; Andoh, Hideaki; Chiang, Chifa; Hirakawa, Yoshihisa

doi:10.2185/jrm.2021-022

Cited by 3 publications

(2 citation statements)

References 45 publications

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“…The wishes and needs of residents and close relatives were not included in the policy making and little attention was paid to their autonomy [ 42 ]. In a recent study, healthcare professionals reported that the highest value should be placed on the autonomy of older people to achieve successful person-centered care that respects their values [ 43 ]. The loss of autonomy and self-determination was also mentioned as contributing to loneliness [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“Precious Time Together Was Taken Away”: Impact of COVID-19 Restrictive Measures on Social Needs and Loneliness from the Perspective of Residents of Nursing Homes, Close Relatives, and Volunteers

Noten

Stoop

Witte

et al. 2022

IJERPH

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During the COVID-19 outbreak in March 2020, restrictive measures (e.g., prohibiting physical visits and group activities) were introduced in nursing homes to protect older residents. Although the importance of social contacts and social activities to fulfill social needs and avoid loneliness is known, these were challenged during the pandemic. This qualitative study specifically focused on how residents, close relatives, and volunteers in nursing homes experienced the restrictive measures in retrospect and gained insights into the impact of the restrictive measures on social needs and loneliness, and the lessons that could be learned. Thirty semi-structured, face-to-face interviews with residents and close relatives, and one online focus group with ten volunteers, were conducted. Recruitment took place at psychogeriatric and somatic units in the Northern, Eastern and Southern regions of the Netherlands and Flanders, Belgium. The interviews and focus group were transcribed verbatim, and an open, inductive approach was used for analysis. Alternative ways of social contact could not fully compensate for physical visits. Generally, participants reported that it was a difficult time, indicated by feelings of loneliness, fear, sadness, and powerlessness. A great diversity in loneliness was reported. The most important reasons for feeling lonely were missing close social contacts and social activities. The diversity in the impact of restrictive measures depended on, e.g., social needs, coping strategies, and character. Restrictive COVID-19 measures in nursing homes resulted in negative emotions and unmet social needs of residents, close relatives, and volunteers. During future outbreaks of the COVID-19 virus or another virus or bacterium, for which restrictive measures may be needed, nursing homes should actively involve residents, close relatives, and volunteers to balance safety, self-determination, and well-being.

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Section: Discussionmentioning

confidence: 99%

“Precious Time Together Was Taken Away”: Impact of COVID-19 Restrictive Measures on Social Needs and Loneliness from the Perspective of Residents of Nursing Homes, Close Relatives, and Volunteers

Noten

Stoop

Witte

et al. 2022

IJERPH

View full text Add to dashboard Cite

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“…Despite widespread efforts to promote ACP, the actual completion rate is still low, partly owing to clinicians' lack of knowledge and awareness of ACP [8,9]. Also due to the absence of legislation specifically encouraging ACP in Japan, it is less practiced in this country than in the United States and the United Kingdom [8], where specific laws and policies on the issue have been adopted.…”

Section: Introductionmentioning

confidence: 99%

Tips for Managing Ethical Challenges in Advance Care Planning: A Qualitative Analysis of Japanese Practical Textbooks for Clinicians

Hirakawa

Aita

Nishikawa

et al. 2022

IJERPH

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(1) Background: While advance care planning (ACP) provides healthcare professionals with valuable tools to meet patients’ needs in a person-centered manner, several potential ethical challenges are inherent to the process. However, recent studies have largely focused on ACP practicalities such as implementation, execution, and completion rather than on the ethical challenges that clinicians routinely encounter in ACP practices. (2) Research question/aim/objectives: This study aimed to identify tips for clinicians managing ethical challenges in ACP practices. (3) Methods: It performed a brief search for all Japanese published books pertaining to ACP practice available as of January 2021 using the keywords “advance care planning (ACP)” and “autonomy.” and analyze the content of nine practical ACP textbooks for clinicians. (4) Results: Two major themes capturing the essential recommendations for managing ethical challenges in ACP were ultimately identified, namely interprofessional ethics and informed consent. (5) Conclusion: The findings suggested tips for managing ethical challenges in ACP: refer to ethical frameworks for interprofessional collaboration and ethical decision making, assess decision-making capacity of family substitute decision makers and one’s eligibility for the role, understand the standard process of informed consent and how to handle situations when the patient are not well informed about the diagnosis and prognosis of non-cancer illness.

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Community-dwelling older people’s experiences of advance care planning with health care professionals: a qualitative systematic review

Iida,

Ishimaru,

Tsujimura

et al. 2024

JBI Evidence Synthesis

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Objective: The objective of this review is to examine community-dwelling older people’s experiences of advance care planning with health care professionals. Introduction: The importance of health care professionals initiating advance care planning for patients has been reported; however, because of the shift from institutionalized to community care, community-dwelling older people have fewer opportunities to discuss these plans with health care professionals compared with those living in other settings. The timely initiation of advance care planning and sustainable discussions among older people, their families, and community health care professionals is necessary and may improve palliative and end-of-life care. Inclusion criteria: Studies with participants aged 60 years and older who have experience with advance care planning and live in their own homes in the community were included. We considered qualitative studies and the qualitative component of mixed methods studies published between January 1999 and April 2023 in English or Japanese. Methods: MEDLINE, CINAHL, Embase, PsycINFO, JSTORE, Scopus, Japan Medical Abstract Society, and CiNii were searched for published papers, and Google Scholar, ProQuest Dissertations and Theses Global, and MedNar were searched for unpublished papers and gray literature. Study selection, critical appraisal, data extraction, and data synthesis were conducted by 2 independent reviewers using the JBI approach and JBI standardized tools. Findings were pooled using a meta-aggregation approach. The synthesized findings were graded using the ConQual approach for establishing confidence in the output of qualitative research syntheses and presented in a Summary of Findings. Results: Five studies published between 2017 and 2022 were included in the review. Each study’s total score was between 6 and 8 out of 10 on the JBI critical appraisal checklist for qualitative research. We extracted 28 findings and aggregated them into 7 categories, generating 3 synthesized findings: i) A trusting relationship with health professionals is essential for older people’s decision-making. Health professionals’ attitudes, knowledge, and skills play a role in this, influencing the perceived quality of care; ii) Shared decision-making and patient-centered communication are essential. Older people feel ambiguity toward end-of-life decision and advance care planning and they want their wishes to be heard in any situation to maintain their autonomy and quality of life; iii) Older people need the appropriate forms and accessible and coordinated care to begin advance care planning. Conclusion: Qualitative studies on community-dwelling older people’s experiences of advance care planning with health care professionals are scarce. The experiences have illustrated that trusting relationships influence people’s perception of the quality of care they receive; there is uncertainty about their future; and they have varying feelings or attitudes toward their impending death, including denial and avoidance. This review highlighted the need for appropriate forms, and accessible and coordinated care to begin advance care planning; thus, an approach that meets the individual’s health and psychosocial status should be selected carefully. Further research is recommended to include older populations from broader geographical and cultural backgrounds and to assess and evaluate the different advance care planning approaches and their implementation processes among groups of community-dwelling older people with different health and psychosocial statuses. Review registration: PROSPERO CRD42020122803

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Improving person-centered advance care planning conversation with older people: a qualitative study of core components perceived by healthcare professionals

Cited by 3 publications

References 45 publications

“Precious Time Together Was Taken Away”: Impact of COVID-19 Restrictive Measures on Social Needs and Loneliness from the Perspective of Residents of Nursing Homes, Close Relatives, and Volunteers

“Precious Time Together Was Taken Away”: Impact of COVID-19 Restrictive Measures on Social Needs and Loneliness from the Perspective of Residents of Nursing Homes, Close Relatives, and Volunteers

Tips for Managing Ethical Challenges in Advance Care Planning: A Qualitative Analysis of Japanese Practical Textbooks for Clinicians

Community-dwelling older people’s experiences of advance care planning with health care professionals: a qualitative systematic review

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