1
|
Sussman T, Lawrence J, Earn A, Wilkie M, Hunter P, Kaasalainen S. Chart based data as a resource for tracking and improving a person-centred palliative approach in long-term care. J Clin Nurs 2022. [PMID: 36225135 DOI: 10.1111/jocn.16558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/29/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To enhance the practice of a person-centred palliative approach in long-term care. BACKGROUND Implementing a person-centred palliative approach in long-term care entails placing residents at the centre of care planning that attends to the 'whole' person, rather than prioritising biomedical needs. DESIGN We conducted a four-stage directed content analysis of long-term care progress notes to meet our study aims and applied the EQUATOR guidelines for qualitative research publication (COREQ). METHODS We qualitatively analysed 78 resident charts across three long-term care homes in southern Ontario to capture the extent to which person-centred care was absent, initiated or implemented in different types of documented care interactions. RESULTS Most residents had interactions related to daily care activities (65/78, 83%), social concerns (65/78, 83%) and treatment decisions (53/78, 68%). By contrast, interactions around pain and discomfort (34/78, 44%) and spirituality (27/78, 35%) were documented for less than half of the residents. Almost all (92%) residents had at least one progress note where staff initiated person-centred care by documenting their preference for a certain type of care, but only a third had at least one progress note that suggested their preference was implemented (35%). CONCLUSIONS While person-centred care is often initiated by nurses and other allied health professionals, changes to care plans to address resident preferences are implemented less often. Nurses and other allied health professionals should be encouraged to elicit care preferences crucial for holistic care planning and equipped with the skills and support to enact collaborative care planning. RELEVANCE TO CLINICAL PRACTICE Collaborative care planning appears relatively absent in charted progress notes, constraining the full implementation of a person-centred palliative approach to care. PATIENT OR PUBLIC CONTRIBUTION An advisory group consisting of long-term care resident and staff representatives informed the overall study design and dissemination of the results.
Collapse
Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Jack Lawrence
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Arielle Earn
- Faculty of Arts & Science, University of Toronto, Toronto, Ontario, Canada
| | - Matt Wilkie
- Faculty of Arts & Science, University of Toronto, Toronto, Ontario, Canada
| | - Paulette Hunter
- Psychology, St Thomas More College, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | |
Collapse
|
2
|
Mechanisms and contextual influences on the implementation of advance care planning for older people in long-term care facilities: A realist review. Int J Nurs Stud 2022; 133:104277. [PMID: 35717924 DOI: 10.1016/j.ijnurstu.2022.104277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 01/10/2023]
|
3
|
Naasan G, Boyd ND, Harrison KL, Garrett SB, D'Aguiar Rosa T, Pérez-Cerpa B, McFarlane S, Miller BL, Ritchie CS. Advance Directive and POLST Documentation in Decedents With Dementia at a Memory Care Center: The Importance of Early Advance Care Planning. Neurol Clin Pract 2022; 12:14-21. [PMID: 36157620 PMCID: PMC9491507 DOI: 10.1212/cpj.0000000000001123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/06/2021] [Indexed: 02/03/2023]
Abstract
Background and Objectives To determine the frequency of and challenges to documentation of advance care planning (ACP) in people with dementia, we conducted a chart review of 746 deceased patients seen at a tertiary memory care center between 2012 and 2017. Methods The rates of documented advance directives (ADs), Physician Order for Life-Sustaining Treatment (POLST), and Do Not Resuscitate (DNR) status were calculated from review of institutional electronic health records. Regression analysis was used to determine associations between ACP documentation and patient characteristics. Results At the time of death, approximately half of the patients had a documented AD and/or DNR status and 37% had a documented POLST; 30% of patients did not have any ACP documentation. Whereas most of the ADs were documented more than 5 years before time of death, POLST and DNR status were documented more frequently within 2 years of time of death. People who presented to clinic at a younger age and who primarily spoke English were more likely to have documented ADs. People living in zip codes with lower household incomes were 2-4.5 times less likely to have a POLST or DNR documentation. Discussion ACP is underutilized in people with dementia, even among those seen in a specialty memory care center. ACP should be introduced early on for people with dementia to ensure patients have a voice in their care.
Collapse
|
4
|
Bronner K, Bodner L, Jox RJ, Marckmann G, Diehl-Schmid J, Hamann J. Entwicklung einer Entscheidungshilfe für partizipative Vorausplanungen für Menschen mit Demenz und deren Angehörige. DER NERVENARZT 2020; 91:1032-1039. [PMID: 32347327 PMCID: PMC7606278 DOI: 10.1007/s00115-020-00911-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hintergrund Eine Demenzdiagnose konfrontiert Betroffene mit vielen gesundheitlichen und sozialen Entscheidungen. Aufgrund der Progression der Demenz ist für eine aktive Teilnahme am Entscheidungsprozess eine rechtzeitige Auseinandersetzung mit diesen Themen ratsam. Eine professionelle Unterstützung kann dabei helfen, frühzeitig gemäß den eigenen Wünschen und Möglichkeiten vorauszuplanen. Material und Methoden In einem mehrstufigen Prozess wurde eine Entscheidungshilfe basierend auf „advance care planning“ und „shared decision making“ entwickelt. Der Prototyp wurde an 8 Patient-Angehörigen-Dyaden aus einer Spezialambulanz für Früherkennung vorgetestet und für deren Bedürfnisse bestmöglich angepasst. In einer Pilotstudie wurde anschließend die Anwendbarkeit der Entscheidungshilfe bei weiteren 19 Patient-Angehörigen-Dyaden (Diagnose einer Alzheimer-Demenz bzw. gemischte Form; MMSE (Mini-Mental-State-Test-Summenwert) >20 und <27) mit ausgebildeten Gesprächsbegleitern als Intervention getestet. Ergebnis Das Ergebnis ist eine schriftliche Entscheidungshilfe für Menschen mit Demenz im Frühstadium und deren Angehörige, welche den Entscheidungsprozess bei wichtigen Themen (Vorsorgevollmacht, Patientenverfügung, Wohnen, Autofahren) unterstützt. Erste Ergebnisse weisen auf eine gute Akzeptanz und Handhabung hin. Patienten und Angehörige beschäftigten sich in hohem Maße mit den Themen und sprachen ihnen hohe Relevanz zu. Diskussion Trotz positiver Rückmeldung der Teilnehmer hinsichtlich Akzeptanz und Anwendbarkeit gab es größere Schwierigkeiten bei der Rekrutierung. Perspektivisch könnte der systematisierte Einsatz einer Entscheidungshilfe als Teil der Routineversorgung dazu beitragen, Entscheidungsprozesse dieser Patientengruppe zu unterstützen. Zusatzmaterial online Die Onlineversion dieses Beitrags (10.1007/s00115-020-00911-2) enthält weitere Infomaterialien. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
Collapse
Affiliation(s)
- Katharina Bronner
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Lea Bodner
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Ralf J Jox
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Georg Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Janine Diehl-Schmid
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Johannes Hamann
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| |
Collapse
|
5
|
Schreyer AG, Dendl LM, Antoch G, Layer G, Beyer L, Schleder S. Interdisziplinäre Tumorkonferenzen in der radiologischen Routine. Radiologe 2020; 60:737-746. [DOI: 10.1007/s00117-020-00685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Ziel
Interdisziplinäre Tumorkonferenzen (Boards) sind regelmäßig stattfindende Konferenzen, bei denen unter medizinischen Experten verschiedener Fachrichtungen versucht wird, einen für den Patienten optimierten Behandlungsplan zu erstellen. Die Anwesenheit eines radiologischen Facharztes ist in nahezu allen relevanten Boards medizinisch unumgänglich. Um die aktuelle Beanspruchung der Radiologie durch derartige Boards systematisch zu evaluieren und auch um aktuelle Zahlen zur möglichen zukünftigen Personalplanung zu liefern, haben wir eine aktuelle Standortbestimmung in der Radiologie in Deutschland durchgeführt.
Material und Methoden
Es erfolgte eine Online-Umfrage. Zur Teilnahme aufgefordert waren alle 33 Lehrstuhlinhaber in der Radiologie sowie nach dem Zufallsprinzip weitere 50 ausgewählte Chefärzte für Radiologie an Krankenhäusern der Schwerpunkt-, oder Maximalversorgung (im Folgenden „Schwerpunktkliniken“ genannt).
Ergebnisse
Es nahmen 26 von 33 radiologischen Instituten (79 %) der Universitätskliniken und 28 von 50 Instituten (56 %) der Schwerpunktkliniken teil. Die Gesamtzahl der durchgeführten Tumorboards beträgt im Durchschnitt 3,3 pro Tag bzw. 16,7 pro Woche an Universitätskliniken und 2,6 pro Tag bzw. 13 pro Woche an Schwerpunktkliniken. Es ergibt sich ein durchschnittlicher zeitlicher Aufwand unter Berücksichtigung der Vorbereitungs- und Durchführungszeit sowie der Durchführungshäufigkeiten von 33,1 h/Woche an Universitätskliniken und 18,2 h/Woche an Schwerpunktkliniken. Dies entspricht bei einer 42-Stunden-Woche an Universitätskliniken 78,8 % und bei einer 40-Stunden-Woche an Schwerpunktkliniken 45,5 % einer Facharztstelle, die für interdisziplinäre Tumorboards notwendig sind.
Schlussfolgerung
Die „sprechende“ Radiologie mit ihren interdisziplinären Tumorboards stellt ein klinisches Selbstverständnis unter aktiver Teilnahme und Moderation durch die Radiologie dar, welches die Patientenversorgung evidenzbasiert verbessert. Dennoch muss bei der in der Medizin vorherrschenden Ressourcenknappheit für künftige Diskussionen bezüglich einer personellen Kompensation die hier erhobene Datengrundlage bzgl. des Personalaufwands der klinischen Radiologie für die Teilnahme an Tumorboards bedacht werden.
Collapse
|
6
|
Advance care planning in different settings for people with dementia: A systematic review and narrative synthesis. Palliat Support Care 2020; 17:707-719. [PMID: 31177997 DOI: 10.1017/s1478951519000257] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Advance care planning (ACP) is identified as being an important process for people with dementia. However, its efficacy for improving outcomes relevant for the individual, carers and the health system has yet to be established. AIM We conducted a systematic review with the aims of testing the efficacy of ACP for people with dementia and describing the settings and population in which it has been evaluated. METHODS A search was completed of electronic databases in August 2016. Articles were included if they described interventions aimed at increasing planning for future care of people with dementia, delivered to the person with dementia, their carers and/or health professionals. RESULTS Of 4,772 articles returned by searches, 30 met the inclusion criteria, testing interventions in nursing home (n= 16) community (n = 10) and acute care (n = 4) settings. Only 18 interventions directly involved the person with dementia, with the remainder focusing on surrogate decision-makers. In all settings, interventions were found effective in increasing ACP practice. In nursing homes, ACP was found to influence care and increase the concordance between end of life wishes and care provided. Interventions in the community were found to improve patient quality of life but were not shown to influence concordance. CONCLUSION Future research should focus on ways to involve people with dementia in decision-making through supported means.
Collapse
|
7
|
Wendrich-van Dael A, Bunn F, Lynch J, Pivodic L, Van den Block L, Goodman C. Advance care planning for people living with dementia: An umbrella review of effectiveness and experiences. Int J Nurs Stud 2020; 107:103576. [DOI: 10.1016/j.ijnurstu.2020.103576] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 11/26/2022]
|
8
|
Ten Koppel M, Pasman HRW, van der Steen JT, van Hout HPJ, Kylänen M, Van den Block L, Smets T, Deliens L, Gambassi G, Froggatt K, Szczerbińska K, Onwuteaka-Philipsen BD. Consensus on treatment for residents in long-term care facilities: perspectives from relatives and care staff in the PACE cross-sectional study in 6 European countries. BMC Palliat Care 2019; 18:73. [PMID: 31464624 PMCID: PMC6714096 DOI: 10.1186/s12904-019-0459-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 08/15/2019] [Indexed: 01/23/2023] Open
Abstract
Background In long-term care facilities often many care providers are involved, which could make it difficult to reach consensus in care. This may harm the relation between care providers and can complicate care. This study aimed to describe and compare in six European countries the degree of consensus among everyone involved in care decisions, from the perspective of relatives and care staff. Another aim was to assess which factors are associated with reporting that full consensus was reached, from the perspective of care staff and relatives. Methods In Belgium, England, Finland, Italy, the Netherlands and Poland a random sample of representative long-term care facilities reported all deaths of residents in the previous three months (n = 1707). This study included residents about whom care staff (n = 1284) and relatives (n = 790) indicated in questionnaires the degree of consensus among all involved in the decision or care process. To account for clustering on facility level, Generalized Estimating Equations were conducted to analyse the degree of consensus across countries and factors associated with full consensus. Results Relatives indicated full consensus in more than half of the residents in all countries (NL 57.9% - EN 68%), except in Finland (40.7%). Care staff reported full consensus in 59.5% of residents in Finland to 86.1% of residents in England. Relatives more likely reported full consensus when: the resident was more comfortable or talked about treatment preferences, a care provider explained what palliative care is, family-physician communication was well perceived, their relation to the resident was other than child (compared to spouse/partner) or if they lived in Poland or Belgium (compared to Finland). Care staff more often indicated full consensus when they rated a higher comfort level of the resident, or if they lived in Italy, the Netherland, Poland or England (compared to Finland). Conclusions In most countries the frequency of full consensus among all involved in care decisions was relatively high. Across countries care staff indicated full consensus more often and no consensus less often than relatives. Advance care planning, comfort and good communication between relatives and care professionals could play a role in achieving full consensus. Electronic supplementary material The online version of this article (10.1186/s12904-019-0459-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M Ten Koppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - H R W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | - J T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - H P J van Hout
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, The Netherlands
| | - M Kylänen
- National Institute for Health and Welfare, Mannerheimintie, 166, Helsinki, Finland
| | - L Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, 103, Brussels, Belgium
| | - T Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, 103, Brussels, Belgium
| | - L Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, 103, Brussels, Belgium
| | - G Gambassi
- Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, Italy
| | - K Froggatt
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, LA1 4YG, UK
| | - K Szczerbińska
- Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, ul. Kopernika 7a, Krakow, Poland
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | | |
Collapse
|
9
|
Sævareid TJL, Lillemoen L, Thoresen L, Førde R, Gjerberg E, Pedersen R. Implementing advance care planning in nursing homes - study protocol of a cluster-randomized clinical trial. BMC Geriatr 2018; 18:180. [PMID: 30103692 PMCID: PMC6090595 DOI: 10.1186/s12877-018-0869-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 07/31/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Close to half of all deaths in Norway occur in nursing homes, which signals a need for good communication on end-of-life care. Advance care planning (ACP) is one means to that end, but in Norwegian nursing homes, ACP is not common. This paper describes the protocol of a project evaluating an ACP-intervention in Norwegian nursing homes. The aims of this research project were to promote the possibility for conversations about the end of life with patients and relatives; promote patient autonomy; create a better foundation for important decisions in the case of medical emergencies and at the end of life; and gain experiences in order to find out what characterizes good ACP and good implementation strategies. METHODS/DESIGN This study was a mixed method study including a cluster-randomized clinical trial. Eight nursing home wards or "clusters" were pair-matched, and one ward from each pair was randomly selected for a 12-month intervention. The intervention consisted of implementing an ACP-guideline. Implementation strategies were training and supervision of project teams and staff in using the guideline, written information to patients and next of kin, and information meetings with nursing home staff. The project was evaluated using both quantitative and qualitative data, and both outcome and process evaluation. Quantitative data included patient chart reviews of ACP, diagnoses, patient preferences for decision-making and treatment, values and wishes that are more general, documented life-prolonging treatment and hospitalizations, and concordance between patient wishes and treatment. The primary outcome was documented ACP. Qualitative data included observations of conversations, interviews with patients, next of kin and health care personnel, logs from project coordinators and conversations, and transcripts from meetings with project teams in the intervention group. DISCUSSION This project attempted to increase the quality and use of ACP in Norwegian nursing homes (NH). A mixed methods approach, inclusion of patients with dementia, attempts to involve, as many patients as possible, and a sustainable implementation plan adapted to real life in nursing homes were strengths of the project.
Collapse
Affiliation(s)
| | - Lillian Lillemoen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450 Oslo, Norway
| | - Lisbeth Thoresen
- Department of Health Sciences, University of Oslo, Forskningsveien 3A Harald Schjelderups hus, 0373 Oslo, Norway
| | - Reidun Førde
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450 Oslo, Norway
| | - Elisabeth Gjerberg
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450 Oslo, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450 Oslo, Norway
| |
Collapse
|
10
|
State of advance care planning research: A descriptive overview of systematic reviews. Palliat Support Care 2018; 17:234-244. [PMID: 30058506 DOI: 10.1017/s1478951518000500] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide an overview of the current state of research of advance care planning (ACP), highlighting most studied topics, publication time, quality of studies and reported outcomes, and to identify gaps to improve ACP receptivity, utilization, implementation, and outcomes. METHOD Cochrane methodology for conducting overviews of systematic reviews. Study quality was assessed using a modified version of the Assessing the Methodological Quality of Systematic Reviews tool. The following databases were searched from inception to April 2017: MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE. Searches were supplemented with gray literature and manual searches. RESULT Eighty systematic reviews, covering 1,662 single articles, show that ACP-related research focuses on nine main topics: (1) ACP as part of end-of-life or palliative care interventions, (2) care decision-making; (3) communication strategies; (4) factors influencing ACP implementation; (5) ACP for specific patient groups, (6) ACP effectiveness; (7) ACP experiences; (8) ACP cost; and (9) ACP outcome measures. The majority of this research was published since 2014, its quality ranges from moderate to low, and reports on documentation, concordance, preferences, and resource utilization outcomes. SIGNIFICANCE OF RESULTS Despite the surge of ACP research, there are major knowledge gaps about ACP initiation, timeliness, optimal content, and impact because of the low quality and fragmentation of the available evidence. Research has mostly focused on discrete aspects within ACP instead of using a holistic evaluative approach that takes into account its intricate working mechanisms, the effects of systems and contexts, and the impacts on multilevel stakeholders. Higher quality studies and innovative interventions are needed to develop effective ACP programs and address research gaps.
Collapse
|
11
|
Piers R, Albers G, Gilissen J, De Lepeleire J, Steyaert J, Van Mechelen W, Steeman E, Dillen L, Vanden Berghe P, Van den Block L. Advance care planning in dementia: recommendations for healthcare professionals. BMC Palliat Care 2018; 17:88. [PMID: 29933758 PMCID: PMC6014017 DOI: 10.1186/s12904-018-0332-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background Advance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual’s preferences and values concerning future treatment and care, including end-of-life care. Despite universal recognition of the importance of ACP for people with dementia, who gradually lose their ability to make informed decisions themselves, ACP still only happens infrequently, and evidence-based recommendations on when and how to perform this complex process are lacking. We aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP in dementia care. Methods Following the Belgian Centre for Evidence-Based Medicine’s procedures, we 1) performed an extensive literature search to identify international guidelines, articles reporting heterogeneous study designs and grey literature, 2) developed recommendations based on the available evidence and expert opinion of the author group, and 3) performed a validation process using written feedback from experts, a survey for end users (healthcare professionals across settings), and two peer-review groups (with geriatricians and general practitioners). Results Based on 67 publications and validation from ten experts, 51 end users and two peer-review groups (24 participants) we developed 32 recommendations covering eight domains: initiation of ACP, evaluation of mental capacity, holding ACP conversations, the role and importance of those close to the person with dementia, ACP with people who find it difficult or impossible to communicate verbally, documentation of wishes and preferences, including information transfer, end-of-life decision-making, and preconditions for optimal implementation of ACP. Almost all recommendations received a grading representing low to very low-quality evidence. Conclusion No high-quality guidelines are available for ACP in dementia care. By combining evidence with expert and user opinions, we have defined a unique set of recommendations for ACP in people living with dementia. These recommendations form a valuable tool for educating healthcare professionals on how to perform ACP across settings.
Collapse
Affiliation(s)
- Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.,End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Gwenda Albers
- Flanders Federation for Palliative Care, Vilvoorde, Belgium
| | - Joni Gilissen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, ACHG, KU Leuven, Leuven, Belgium
| | - Jan Steyaert
- Department of Sociology, University of Antwerp, Antwerp, Belgium.,Flemish Expertise Centre on Dementia Care, Antwerp, Belgium
| | - Wouter Van Mechelen
- Department of Public Health and Primary Care, ACHG, KU Leuven, Leuven, Belgium
| | - Els Steeman
- Academic Centre for Nursing and Midwifery, KULeuven, Leuven, Belgium
| | - Let Dillen
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium.
| |
Collapse
|
12
|
Measuring Family Members' Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4621592. [PMID: 28706945 PMCID: PMC5494554 DOI: 10.1155/2017/4621592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/28/2017] [Accepted: 04/20/2017] [Indexed: 11/17/2022]
Abstract
RATIONALE Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families' satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families' perceptions of the EOLC experience and to be self-administered. METHODS AND RESULTS Phase 1. A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added. PHASE 2 The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered. PHASE 3 The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach's alpha coefficients (range: .88-.94) indicated internal consistency. CONCLUSION This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families' perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning.
Collapse
|
13
|
Gjerberg E, Lillemoen L, Weaver K, Pedersen R, Førde R. Advance care planning in Norwegian nursing homes. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:447-450. [PMID: 28332797 DOI: 10.4045/tidsskr.16.0284] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Nursing home patients are often frail and have a number of chronic conditions. Increased risk of critical events, hospitalisations and death indicates the need for dialogue with patients and their next of kin about the future, how to agree on sound decisions and what should happen if the patient’s health condition deteriorates. Previous studies have shown that only a minority of nursing homes practise this type of advance care planning. MATERIAL AND METHOD In early summer 2014, a questionnaire was sent to all Norwegian nursing homes, containing questions about the prevalence and content of advance care planning. RESULTS A total of 57 % (486 nursing homes) responded to the survey. Approximately two-thirds reported that they «always’ or «usually’ undertook advance care planning and around one-third of them had written guidelines. The conversations primarily took place when the patient’s health condition deteriorated, when the patient entered the last phase of life, or in connection with the admission interview. Hospitalisation, pain relief and cardiopulmonary resuscitation (CPR) were the most frequent topics. Next of kin and the nursing home doctor participated most often in the interviews, while the patients participated more seldom. INTERPRETATION There were large variations between the nursing homes with regard to advance care planning. This may partly be explained by the lack of national guidelines, and partly by the fact that this is a relatively recent discussion in Norway. The infrequent participation by patients in the conversations is probably associated with the fact that among them a high proportion are cognitively impaired, the availability of medical resources is low, and a culture of patient participation is insufficiently developed.
Collapse
|
14
|
Gilissen J, Pivodic L, Smets T, Gastmans C, Vander Stichele R, Deliens L, Van den Block L. Preconditions for successful advance care planning in nursing homes: A systematic review. Int J Nurs Stud 2016; 66:47-59. [PMID: 27987411 DOI: 10.1016/j.ijnurstu.2016.12.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is growing evidence of the potential effectiveness of advance care planning. Yet important knowledge gaps remain regarding the preconditions for successful implementation of advance care planning in the nursing home setting. We aim to identify the preconditions related to successful advance care planning in the nursing home setting. By specifying those, we would be able to make well-founded choices for the future design and planning of advance care planning intervention programs. DESIGN A systematic review. DATA SOURCES PubMed, PsycINFO, EMBASE and CINAHL. REVIEW METHODS Two authors independently screened publications. One author assessed methodological quality and extracted textual data, which was double-checked for a random sample. We extracted textual data and used thematic synthesis to identify "preconditions", defined as requirements, conditions and elements necessary to achieve the desired outcome of advance care planning, i.e. attaining concordance between residents' preferences and actual care or treatment received at the end of life. MAIN FINDINGS Based on 38 publications, we identified 17 preconditions at five different levels: resident, family, health-care professional, facility and community. Most preconditions were situated on multiple levels but the majority addressed professionals and the nursing home itself. We summarized preconditions in five domains: to have sufficient knowledge and skills, to be willing and able to participate in advance care planning, to have good relationships, to have an administrative system in place, and contextual factors supporting advance care planning within the nursing home. CONCLUSION There are multiple preconditions related to successfully implementing advance care planning in the complex nursing home setting that operate at micro, meso and macro level. Future interventions need to address these multiple domains and levels in a whole-system approach in order to be better implementable and more sustainable, while simultaneously target the important role of the health-care professional and the facility itself.
Collapse
Affiliation(s)
- Joni Gilissen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
| | - Lara Pivodic
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
| | - Tinne Smets
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Box 7001, 3000 Leuven, Belgium
| | | | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Medical Oncology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| |
Collapse
|
15
|
Thoresen L, Lillemoen L. "I just think that we should be informed" a qualitative study of family involvement in advance care planning in nursing homes. BMC Med Ethics 2016; 17:72. [PMID: 27829409 PMCID: PMC5103414 DOI: 10.1186/s12910-016-0156-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND As part of the research project "End-of-life Communication in Nursing Homes. Patient Preferences and Participation", we have studied how Advance Care Planning (ACP) is carried out in eight Norwegian nursing homes. The concept of ACP is a process for improving patient autonomy and communication in the context of progressive illness, anticipated deterioration and end-of-life care. While an individualistic autonomy based attitude is at the fore in most studies on ACP, there is a lack of empirical studies on how family members' participation and involvement in ACP- conversations may promote nursing home patients' participation in decisions on future treatment and end-of-life care. Based on empirical data and family ethics perspectives, the purpose of this study is to add insights to the complexity of ACP-conversations and illuminate how a family ethics perspective may improve the quality of the ACP and promote nursing home patients' participation in advance care planning. METHODS Participant observations of ACP-conversations in eight nursing homes. The observations were followed by interviews with patients and relatives together on how they experienced being part of the conversation, and expressing their views on future medical treatment, hospitalization and end-of-life issues. RESULTS We found that the way nursing home patients and relatives are connected and related to each other, constitutes an intertwined unit. Further, we found that relatives' involvement and participation in ACP- conversations is significant to uncover, and give the nursing home staff insight into, what is important in the nursing home patient's life at the time. The third analytical theme is patients' and relatives' shared experiences of the dying and death of others. Drawing on past experiences can be a way of introducing or talking about death. CONCLUSIONS An individual autonomy approach in advance care planning should be complemented with a family ethics approach. To be open to family ethics when planning for the patient's future in the nursing home is to be open to diversity and nuances and to the significance of the patient's former life and experiences.
Collapse
Affiliation(s)
- Lisbeth Thoresen
- Centre for Medical Ethics and Department of Health Sciences, Institute of Health and Society, University of Oslo, Postboks 1130, Blindern, 0318 Oslo, Norway
| | - Lillian Lillemoen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Postboks 1130, Blindern, 0318 Oslo, Norway
| |
Collapse
|
16
|
Thoresen L, Ahlzén R, Solbrække KN. Advance Care Planning in Norwegian nursing homes-Who is it for? J Aging Stud 2016; 38:16-26. [PMID: 27531449 DOI: 10.1016/j.jaging.2016.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/18/2016] [Accepted: 04/05/2016] [Indexed: 11/28/2022]
Abstract
Advance care planning (ACP) is an international concept for improving patient autonomy and communication in the context of anticipated deterioration and end-of-life care. In a preparatory conversation, health care professionals facilitate one or more conversations where nursing home residents are invited to reflect on, and articulate wishes and preferences concerning future medical treatment and end-of-life care. Our aim with this study was to increase knowledge of existing ACP practices in Norwegian nursing homes. We wanted to know how nursing home residents, relatives and nursing home staff take part in the conversations, and to what extent these conversations can be regarded as promoting autonomy, legal rights and individual needs for the residents. We conducted participant observation of seven preparatory conversations, followed by interviews with health care staff (together) and resident and relative (together). In the result section, we present an informative case example of an ACP conversation where common and important characteristics running through our data are present. These are further elaborated under the following headings: Life critical questions, Residents' quiet participation in the conversations, the Dying phase - a clinical issue, Nurses and physicians; different domains and Timing. We find that nursing home staff in our study wants to contribute to open awareness, autonomy and a good death, but there are little reflections about the purpose and content of the conversations, how they should be carried out and when, and what frail nursing home residents are able to understand and express in ACP conversations.
Collapse
Affiliation(s)
- Lisbeth Thoresen
- University of Oslo Centre for Medical Ethics, Kirkeveien 166, Fredrik Holsts hus, 0450 Oslo Norway.
| | - Rolf Ahlzén
- University of Karlstad, Universitetsgatan 2, 651 88 Karlstad, Sverige, Sweden
| | - Kari Nyheim Solbrække
- University of Oslo Centre for Medical Ethics, Kirkeveien 166, Fredrik Holsts hus, 0450 Oslo Norway
| |
Collapse
|
17
|
Ampe S, Sevenants A, Smets T, Declercq A, Van Audenhove C. Advance care planning for nursing home residents with dementia: policy vs. practice. J Adv Nurs 2015; 72:569-81. [DOI: 10.1111/jan.12854] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Sophie Ampe
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | - Aline Sevenants
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | - Tinne Smets
- Vrije Universiteit Brussel; End-of-Life Care Research Group; Belgium
| | - Anja Declercq
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | | |
Collapse
|
18
|
Cornally N, McGlade C, Weathers E, Daly E, Fitzgerald C, O'Caoimh R, Coffey A, Molloy DW. Evaluating the systematic implementation of the 'Let Me Decide' advance care planning programme in long term care through focus groups: staff perspectives. BMC Palliat Care 2015; 14:55. [PMID: 26531317 PMCID: PMC4632678 DOI: 10.1186/s12904-015-0051-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 10/19/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The 'Let Me Decide' Advance Care Planning (LMD-ACP) programme offers a structured approach to End-of-Life (EoL) care planning in long-term care for residents with and without capacity to complete an advance care directive/plan. The programme was implemented in three homes in the South of Ireland, with a view to improving quality of care at end of life. This paper will present an evaluation of the systematic implementation of the LMD-ACP programme in the homes. METHODS Focus groups were conducted with 15 Clinical Nurse Managers and two Directors of Nursing where the programme had been implemented. A semi-structured topic guide was used to direct questions that addressed implementation process, challenges implementing advance care planning, advantages/disadvantages and recommendations for the future. Data was analysed using manifest content analysis. RESULTS Five key categories emerged, with 16 corresponding subcategories. These subcategories emerged as a result of 37 codes. Key benefits of the programme included enhancing communication, changing the care culture, promoting preference-based care and avoiding crisis decision making. Establishing capacity among residents and indecision were among the main challenges reported by staff. DISCUSSION A number of recommendations were proposed by participants and included multi-disciplinary team involvement, and a blended approach to education on the topic. According to participants relationships with residents deepened, there was a more open and honest environment with family, end of life care focused more on symptom management, comfort and addressing spiritual care needs as opposed to crisis decision making and family conflict. CONCLUSION The introduction of the LMD-ACP programme enhanced the delivery of care in the long-term care sites and led to a more open and positive care environment.
Collapse
Affiliation(s)
- Nicola Cornally
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland.
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Ciara McGlade
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland.
- Health Service Executive, Mallow General Hospital, Mallow, Cork, Ireland.
| | - Elizabeth Weathers
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland.
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - Edel Daly
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland.
| | - Carol Fitzgerald
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland.
| | - Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland.
- Health Research Board Clinical Research Facility Galway, National University of Ireland, Geata an Eolais, University Road, Galway, Ireland.
| | - Alice Coffey
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland.
| |
Collapse
|
19
|
O’Caoimh R, Sweeney C, Hynes H, McGlade C, Cornally N, Daly E, Weathers E, Coffey A, FitzGerald C, Healy E, O’Connell E, O’Keeffe G, O'Sullivan R, Timmons S, Foley T, Creed E, Hynes M, Twomey A, Sammon M, Cullen D, Mullan E, Orfila F, Paúl C, Clarnette R, Campbell S, Lupari M, McCarthy S, Sahm L, Byrne S, O’Leary C, O'Shea S, O’Donoghue J, McAdoo J, Kearney P, Galvin P, O’Byrne-Maguire I, Browne J, Kenny R, O’Herlihy E, O’Toole P, McFarlane A, Deery M, Bond R, Martin J, Shorten G, Molloy W. COLLaboration on AGEing-COLLAGE: Ireland's three star reference site for the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2015.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|