The advance directive prevalence in long‐term care: A comparison of relationships between a nurse practitioner healthcare model and a traditional healthcare model

Lawrence, James F.

doi:10.1111/j.1745-7599.2008.00381.x

Cited by 21 publications

(11 citation statements)

References 22 publications

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“…This may explain the greater use of teams in these conversations in LTC. Physicians, nurse practitioners and nurses have been shown to be effective for engaging in ACP with patients12 13 but little is known about the impact of team versus individual healthcare provider participation in ACP discussions.…”

Section: Discussionmentioning

confidence: 99%

Advance care planning discussions among residents of long term care and designated assisted living: experience from Calgary, Alberta

Dyason

Simon²,

Martin

2013

BMJ Support Palliat Care

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ObjectivesPatients, physicians and the healthcare system are faced with the challenge of determining, and respecting, the medical wishes of an aging population. Our study sought to describe who participates in advance care planning (ACP) and decision-making for patients in long-term care and designated assisted living.MethodsIn 2008, Alberta Health Services initiated its ‘Advance Care Planning: Goals of Care Designation’ (Adult) policy in the Calgary zone. This policy encouraged discussions about goals of care and used a tracking form to capture these conversations. A postpolicy implementation chart review was performed at 3 time points: at baseline, at 6 months and at 18 months post implementation in long term care (LTC) and designated assisted living sites.Results166 charts were reviewed and 90% had a documented goals of care order. Less than half of residents (47%) were documented as participating in conversations and they were less likely to participate if they had cognitive impairment and were living in LTC. Documented family participation was more prevalent in LTC (51% vs 11%). Nurses participated in 67% of documented conversations with only 34% of discussions documenting physician involvement.ConclusionsThis study identifies the lack of documented resident participation in ACP in LTC. While this finding may be explained by the high prevalence of cognitive impairment in our population, it raises questions about the optimal approach to ACP in LTC. In this setting, ACP appears to be more about relational autonomy than it is about patient autonomy.

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Section: Discussionmentioning

confidence: 99%

Advance care planning discussions among residents of long term care and designated assisted living: experience from Calgary, Alberta

Dyason

Simon²,

Martin

2013

BMJ Support Palliat Care

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“…This latter type of planning, called advance care planning , also encompasses the designation of a health care proxy, completion of a living will, and, in some states, the completion of a Physician’s Orders for Life-Sustaining Treatment form. Although these are important aspects of future planning, which have received broad recognition as an important part of late-life care (Bomba, Doniger, & Vermilyea, 2004; Camhi et al, 2009; Clements, 2009; Golden, Corvea, Dang, Llorente, & Silverman, 2009; Lawrence, 2009), this chapter focuses on late-life care planning for a time of increasing disability or frailty that often accompanies aging.…”

Section: What Is Preparation For Future Care?mentioning

confidence: 99%

Planning and Decision Making for Care Transitions

Sörensen¹,

Mak²,

Pinquart³

2011

annu rev gerontol geriatr

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The need to plan for future health care and residential adjustments increases with age, growing frailty, and restrictions in coverage of long-term care and will continue to grow with population aging. Older adults’ lack of financial preparation for health care costs, insufficient knowledge about available options, and inadequate communication about care-related values has become an increasing public health challenge. This chapter describes a model of Preparation for Future Care (PFC), which encompasses different levels and domains of planning. Research about the extent to which planning is helpful in navigating care transitions is reviewed, and barriers and facilitators of planning including individual, familial, cultural, and national long-term care policy factors are discussed. Planning in the context of dementia and practical approaches that can be taken to enhance PFC is addressed, as well as recommendations for future research in the area of planning and decision making in the context of care transitions.

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“…Subsequently, four additional studies met this inclusion criterion [5, 34, 36, 37]. For the remaining, 18 studies did not meet the criteria [40–57], one involved a cointervention [58], and one did not provide adequate detail of the ACP component of the program [59]. Therefore, six ACP programs were evaluated to identify their impacts.…”

Section: Resultsmentioning

confidence: 99%

A Review of Advance Care Planning Programs in Long-Term Care Homes: Are They Dementia Friendly?

Wickson-Griffiths

Kaasalainen

Ploeg

et al. 2014

Nursing Research and Practice

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Background. Persons living with dementia in the long-term care home (LTCH) setting have a number of unique needs, including those related to planning for their futures. It is therefore important to understand the advance care planning (ACP) programs that have been developed and their impact in order for LTCH settings to select a program that best suits residents' needs. Methods. Four electronic databases were searched from 1990 to 2013, for studies that evaluated the impact of advance care planning programs implemented in the LTCH setting. Studies were critically reviewed according to rigour, impact, and the consideration of the values of residents with dementia and their family members according to the Dementia Policy Lens Toolkit. Results and Conclusion. Six ACP programs were included in the review, five of which could be considered more “dementia friendly.” The programs indicated a variety of positive impacts in the planning and provision of end-of-life care for residents and their family members, most notably, increased ACP discussion and documentation. In moving forward, it will be important to evaluate the incorporation of residents with dementia's values when designing or implementing ACP interventions in the LTCH settings.

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The advance directive prevalence in long‐term care: A comparison of relationships between a nurse practitioner healthcare model and a traditional healthcare model

Cited by 21 publications

References 22 publications

Advance care planning discussions among residents of long term care and designated assisted living: experience from Calgary, Alberta

Advance care planning discussions among residents of long term care and designated assisted living: experience from Calgary, Alberta

Planning and Decision Making for Care Transitions

A Review of Advance Care Planning Programs in Long-Term Care Homes: Are They Dementia Friendly?

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