Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers

Clin Interv Aging. 2019 May 29;14:997-1005. doi: 10.2147/CIA.S203298. eCollection 2019.

Abstract

Purpose: Advance care planning (ACP) performed by regular staff, which also includes patients with cognitive impairment and their next of kin, is scarcely studied. Thus, we planned an implementation study including key stakeholders (patients, next of kin, and health care personnel) using a whole-ward/system approach to ACP. We explored how they experienced ACP and its significance. Patients and methods: This qualitative study is part of a mixed-method implementation study of ACP. In four nursing homes, we did qualitative interviews and audio-recordings of meetings. We completed 20 individual semistructured interviews with participants soon after ACP conversations. The interviews included patients with cognitive impairment, their next of kin, and health care personnel. We also conducted four focus group interviews with staff and managers in the nursing homes and audio-recorded four network meetings with the project teams implementing ACP. Results: All participants appreciated taking part in ACP. Patients and next of kin focused more on the past and present than future treatment preferences. Still, ACP seemed to contribute to a stronger patient focus on end-of-life conversations. More generally, ACP seemed to contribute to valuable information for future decision-making, trusting relations, improved end-of-life communication, and saving time and resources. Conclusion: Safeguarding a strong patient focus on ACP and fostering a person-centered care culture in nursing home wards seem to be achievable through implementation of ACP that includes regular staff, patients with cognitive impairment, and their next of kin.

Keywords: cognitive impairment; implementation; person-centered care; qualitative; whole-system approach.

MeSH terms

  • Adult
  • Advance Care Planning*
  • Aged
  • Attitude of Health Personnel
  • Caregivers / psychology
  • Cognitive Dysfunction* / diagnosis
  • Cognitive Dysfunction* / psychology
  • Decision Making / ethics
  • Female
  • Focus Groups
  • Homes for the Aged / organization & administration*
  • Humans
  • Male
  • Nursing Homes / organization & administration*
  • Patient-Centered Care* / ethics
  • Patient-Centered Care* / methods
  • Professional-Family Relations / ethics
  • Qualitative Research