17 Conversations on Living and Dying: Facilitating Advance Care Planning for Older People Living with Frailty. A Qualitative Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i1-i6
Author(s):  
S Combes ◽  
C Nicholson ◽  
K Gillett ◽  
C Norton
Keyword(s):  
Older People ◽  
Advance Care Planning ◽  
Behavioural Change ◽  
Family Members ◽  
Community Dwelling ◽  
Care Planning ◽  
Structured Interviews ◽  
Living Well ◽  
Advance Care ◽  
Community Dwelling Older People

Abstract Introduction Advance care planning (ACP) is a process that supports people to articulate their future care preferences. This process is a priority for older people living with frailty due to their vulnerability to sudden deterioration, something that has been highlighted during the current pandemic. However, ACP is uncommon for older people living with frailty, hindering choice and person-centred end-of-life care. This study aimed to identify the barriers, facilitators and behaviours required to support cognitively-able, community-dwelling older people living with frailty to engage with ACP. Findings will inform the development an ACP intervention underpinned by behavioural change theory. Methods Semi-structured interviews with community-dwelling older people living with frailty (Clinical Frailty Score 6 or 7) and family members were audio-recorded, filmed and transcribed verbatim. A thematic analysis framework was developed using a recent systematic review, and expanded to reflect new themes. Results Ten older people living with frailty and eight family members were interviewed. The older people’s median age was 85 and seven were female. Family members were spouses (n = 4) and children (n = 4). The key findings were that: the meaning of ACP could be unclear and at times confusing; many of the older people believed ACP was not relevant to them; relationships and relational autonomy were of greater relevance to older people than autonomous decision-making; older people were more interested in living well now than in planning for the future. Conclusions Older people living with frailty need to be engaged with ACP in a way that helps them to understand what ACP is and why it is relevant for them. Professionals need to develop their skills in assessing readiness and facilitating ACP conversations with this population at the older person’s pace. Reframing ACP to include living well now alongside encouraging family inclusion would also relate better to this populations’ lives.

scholarly journals Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024762 ◽  
Author(s):  
Jolien Jeltje Glaudemans ◽  
Eric Moll van Charante ◽  
Jan Wind ◽  
John Jacob Oosterink ◽  
Dick Ludolf Willems
Keyword(s):  
Qualitative Study ◽  
Older People ◽  
General Practitioners ◽  
Advance Care Planning ◽  
Older Patients ◽  
Ad Hoc ◽  
Daily Practice ◽  
Community Dwelling ◽  
Care Planning ◽  
Advance Care

ObjectivesAdvance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice.Design, setting and participantsA qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews.ResultsApproaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive geriatric assessments and periodic assessments. Meetings were aimed at making agreements in anticipation of future care, at providing information and encouraging older people to take further steps in ACP. With ad hoc approaches, respondents discussed only one or two topics related to the near future. Ad hoc ACP was mainly done with deteriorating patients or when patients or family initiated ACP. Systematic and ad hoc approaches were used simultaneously or sequentially and were both used for initiating and following up on ACP. Due to a lack of time and knowledge of other occasions and topics than the ones respondents used, respondents seemed to underuse many occasions and topics.ConclusionsAwareness of appropriate systematic and ad hoc approaches for ACP, and the focus on providing information and encouraging older people to take further steps in ACP reported in this study can support GPs and improve older patients’ access to ACP.

Discussing advance care planning: insights from older people living in nursing homes and from family members

2017 ◽  
Vol 30 (4) ◽  
pp. 569-579 ◽  
Author(s):  
Francesca Ingravallo ◽  
Veronica Mignani ◽  
Elena Mariani ◽  
Giovanni Ottoboni ◽  
Marie Christine Melon ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Older People ◽  
Advance Care Planning ◽  
Family Members ◽  
Nursing Home Residents ◽  
Care Planning ◽  
People With Dementia ◽  
Advance Care ◽  
The Right ◽  
Age Range

ABSTRACTBackground:Evidence concerning when and in which manner older people living in nursing homes (NHs) would prefer to discuss advance care planning (ACP) is still scarce. This study explored the attitudes of NH residents and family members toward ACP and their opinions as to the right time to broach the subject, the manner in which it should be approached, and the content of ACP.Methods:This was a qualitative study using face-to-face interviews with 30 residents (age range 66–94), and 10 family members from 4 Italian NHs. The interviews were analyzed using content analysis.Results:Three main themes were identified: (1) life in the NH, including thoughts about life in a nursing home, residents’ concerns, wishes and fears, and communication barriers; (2) future plans and attitudes toward ACP, including attitudes toward planning for the future and plans already made, and attitudes toward and barriers against ACP; (3) contents and manner of ACP, including contents of ACP discussions, the right moment to introduce ACP, with whom it is better to discuss ACP, and attitudes toward advance directives.Conclusions:ACP was a welcome intervention for the majority of participants, but an individualized assessment of the person's readiness to be involved in ACP is needed. For people with dementia, it is essential to identify the right time to introduce ACP before NH admission. Participants in our study suggested that ACP should include palliative care and practical issues, and that in the NH setting all staff and family members may have a valuable role in ACP.

P-43 Capacity assessment for advance care planning in older people with cognitive impairment

2015 ◽  
Vol 5 (Suppl 2) ◽  
pp. A56.3-A57
Author(s):  
O Kiriaev ◽  
Emme Chacko ◽  
JD Jurgens ◽  
Meagan Ramages ◽  
P Malpas ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Advance Care Planning ◽  
Capacity Assessment ◽  
Care Planning ◽  
Advance Care

scholarly journals Advance Care Planning for Older People with Cancer and Its Implications in Asia: Highlighting the Mental Capacity and Relational Autonomy

Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 43 ◽  
Author(s):  
Cheng-Pei Lin ◽  
Shao-Yi Cheng ◽  
Ping-Jen Chen
Keyword(s):  
Older People ◽  
Advance Care Planning ◽  
Positive Impact ◽  
Mental Capacity ◽  
Capacity Assessment ◽  
Successful Implementation ◽  
Care Planning ◽  
Relational Autonomy ◽  
Healthcare Outcomes ◽  
Advance Care

With dramatically increasing proportions of older people, global ageing has remarkably influenced healthcare services and policy making worldwide. Older people represent the majority of patients with cancer, leading to the increasing demand of healthcare due to more comorbidities and inherent frailty. The preference of older people with cancer are often ignored, and they are considered incapable of making choices for themselves, particularly medical decisions. This might impede the provision of their preferred care and lead to poor healthcare outcomes. Advance care planning (ACP) is considered an effective intervention to assist older people to think ahead and make a choice in accordance with their wishes when they possess capacity to do so. The implementation of ACP can potentially lead to positive impact for patients and families. However, the assessment of mental capacity among older adults with cancer might be a crucial concern when implementing ACP, as loss of mental capacity occurs frequently during disease deterioration and functional decline. This article aims to answer the following questions by exploring the existing evidence. How does ACP develop for older people with cancer? How can we measure mental capacity and what kind of principles for assessment we should apply? What are the facilitators and barriers when implementing an ACP in this population? Furthermore, a discussion about cultural adaptation and relevant legislation in Asia is elucidated for better understanding about its cultural appropriateness and the implications. Finally, recommendations in relation to early intervention with routine monitoring and examination of capacity assessment in clinical practice when delivering ACP, reconciling patient autonomy and family values by applying the concept of relational autonomy, and a corresponding legislation and public education should be in place in Asia. More research on ACP and capacity assessment in different cultural contexts and policy frameworks is highlighted as crucial factors for successful implementation of ACP.

Limited engagement in, yet clear preferences for advance care planning in young-onset dementia: An exploratory interview-study with family caregivers

2019 ◽  
Vol 33 (9) ◽  
pp. 1166-1175 ◽  
Author(s):  
Romy Van Rickstal ◽  
Aline De Vleminck ◽  
Melissa D Aldridge ◽  
Sean R Morrison ◽  
Raymond T Koopmans ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Advance Care Planning ◽  
Quality Care ◽  
Third Party ◽  
Care Planning ◽  
Structured Interviews ◽  
Young Onset ◽  
People With Dementia ◽  
Advance Care ◽  
Young Onset Dementia

Background: The significance of advance care planning in dementia is widely acknowledged. Despite the suggestion that younger people with dementia and their family might have distinct needs and preferences in this area, studies on advance care planning in young-onset dementia are absent. Aim: We aim to explore (1) whether family caregivers had already engaged in advance care planning with patients and/ or professionals and the accompanying reasons and (2) family caregivers’ preferences for how to ideally engage in the process with patients, family and professionals. Design: A qualitative study was conducted: we analysed semi-structured interviews ( n = 15) through the method of constant comparative analysis. Setting/participants: We included Flemish family caregivers of persons with young-onset dementia. Results: Plans for the future typically concerned non-medical affairs. Participants’ limited engagement in advance care planning was clarified through several reasons: not considering it useful, hindering patient behaviour, adopting a day-to-day attitude, caregivers emotionally protecting themselves and uncertainty about patients’ cognitive competence. However, endorsement for advance care planning showed from respondents’ preferences that it should be initiated timely, by a third party, and emphasize patients’ remaining capacities. Finally, the need for information and high-quality care emerged. Conclusion: A gap of knowledge, of information and in care intertwiningly hinder advance care planning. In young-onset dementia, engaging in advance care planning is not an option equally accessible as not doing so. Policy makers, institutions and professionals could reflect on their responsibility in providing these patients and caregivers an actual choice to engage in advance care planning or not.

scholarly journals Elephant in the room - Family members´ perspectives on advance care planning

2020 ◽  
Vol 38 (4) ◽  
pp. 421-429
Author(s):  
Lisa Kastbom ◽  
Marit Karlsson ◽  
Magnus Falk ◽  
Anna Milberg
Keyword(s):  
Advance Care Planning ◽  
Family Members ◽  
Care Planning ◽  
Advance Care
Sign in / Sign up

Export Citation Format

Share Document