Annals of Long-Term Care: Clinical Care and Aging. 2015;23(11):45-56.
A research team in Ireland has shown that implementing an advance care planning and palliative care education intervention program in nursing homes can have a positive effect of the quality of end-of-life care provided to residents.
Advance care planning is a process of communication between an individual, their health care providers, and their loved ones about their values and preferences for their future care. In the event that the person loses the capacity to make or communicate these preferences, decisions regarding future care be documented in an advance care directive.
Researchers from the Centre for Gerontology and Rehabilitation and the Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland, implemented a structured advance care planning program in three nursing homes in Ireland. The smallest of these homes had 79 beds, and the other two homes had 97 and 120 beds, respectively. The “Let Me Decide” advance care planning program was implemented for residents with and without capacity to complete an advance care directive or plan. This program had been used previously in Canada and Australia with documented success, and involves educating staff on advance care planning, completing an advance care directive for residents, and implementing palliative care approaches at the resident’s end of life.
Educational materials regarding advance care planning were provided to residents and their family members, and structured advance care directives and end-of-life decision care plans were used. The program also included a structured approach to assessing the decision-making capacity of residents, which is an important component of any advance care planning process. Residents were evaluated using the standardized mini mental state examination and the Screening Instrument to Assess Competency to Complete and Advance Directive, a quality assurance measure unique to the “Let Me Decide” program that measures capacity to understand the details surrounding end-of-life decisions.
In order to evaluate the success of the program, focus groups were conducted with 15 clinical nurse managers and two directors of nursing where the program had been implemented. The respondents reported that, although they were at first reticent about approaching the topic of advance care planning with residents, implementation of the program was aided by support from the research team as well as the user-friendliness and convenience of the resources provided. Key benefits of the program that were identified included enhancing communication, changing the care culture, promoting preference-based care, and avoiding crisis decision-making. Respondents reported that their relationships with residents deepened, communication with family was more open and honest, and end-of-life care had an increased focus on symptom management, comfort, and addressing the spiritual care needs of residents.
Among the challenges reported by staff, the most common were establishing capacity among residents and indecision on the part of some residents and their loved ones concerning their end-of-life care preferences.
Participants of the focus groups proposed recommendations for further improving the program. These included multi-disciplinary team involvement and a blended approach to education on the topic of care planning.
Overall, the program was well-received, and feedback from the focus group participants indicated that it had a positive impact on the overall end-of-life care decision-making process. The findings were reported in BMC Palliative Care (http://bit.ly/1OE45p8).
The authors of the study recommend that the implementation of the “Let Me Decide” program be extended to other long-term care practices.—Kara Rosania