Advance care planning practices in the nursing home setting: A secondary analysis

2021 ◽  
Author(s):  
Bridget L Laging ◽  
Rhonda Nay ◽  
Michael Bauer ◽  
Rohan Laging ◽  
Katie Walker ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Advance Care Planning ◽  
Healthcare Workers ◽  
Secondary Analysis ◽  
Ethnographic Study ◽  
Care Planning ◽  
Home Setting ◽  
Nursing Home Setting ◽  
Advance Care

Abstract Background and Objectives Advance care planning is intended to support resident’s preferences regarding health decisions, even when they can no longer participate. Little is known about the power discourses influencing how residents, family-members, and healthcare workers engage in advance care planning and how advance care directives are used if conflict arises. A large critical ethnographic study was conducted exploring decision making when a resident’s health deteriorates in the nursing home setting. Advance care planning practices were not the focus of the original study, but the richness of the data warranted further exploration. A new research question was developed to inform a secondary analysis: How does advance care planning influence the relationship between resident values and clinical expertise when determining a direction of care at the time of a resident deterioration? Research Design and Methods A secondary analysis of data from an ethnographic study involving 184 hours of participatory observation, 40 semi-structured interviews and advance care planning policies and document review undertaken in in two nursing homes in Melbourne, Australia. Results Advance care planning may result in inaccurate documentation of residents’ preferences and devalue clinical decision-making and communication with residents and family-members at the time of deterioration. Discussion and Implications Advance care planning may contribute towards a reductionist approach to decision-making. There is an urgent need for the development of evidence-based policy and legislation to support residents, families, and healthcare workers to make appropriate decisions, including withholding invasive treatment when a resident deteriorates.

scholarly journals Barriers and facilitators to implementing a pragmatic trial to improve advance care planning in the nursing home setting

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer A. Palmer ◽  
Victoria A. Parker ◽  
Vincent Mor ◽  
Angelo E. Volandes ◽  
Lacey R. Barre ◽  
...  
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Pragmatic Trial ◽  
Barriers And Facilitators ◽  
Care Planning ◽  
Home Setting ◽  
Nursing Home Setting ◽  
Advance Care

P3-532: ADVANCE CARE PLANNING FOR COGNITIVELY IMPAIRED INDIVIDUALS WITHIN THE NURSING HOME SETTING

2006 ◽  
Vol 14 (7S_Part_25) ◽  
pp. P1326-P1327
Author(s):  
Lacey Loomer ◽  
Susan Mitchell ◽  
Vincent Mor ◽  
Angelo Volandes
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Cognitively Impaired ◽  
Care Planning ◽  
Home Setting ◽  
Nursing Home Setting ◽  
Advance Care

Advance Care Planning in the Nursing Home Setting: A Practice Improvement Evaluation

2018 ◽  
Vol 14 (4) ◽  
pp. 328-345 ◽  
Author(s):  
Alexis C. Kezirian ◽  
Margaret J. McGregor ◽  
Umilla Stead ◽  
Timothy Sakaluk ◽  
Beverly Spring ◽  
...  
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Care Planning ◽  
Home Setting ◽  
Practice Improvement ◽  
Nursing Home Setting ◽  
Advance Care

scholarly journals An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting

2016 ◽  
Vol 64 (11) ◽  
pp. 2385-2392 ◽  
Author(s):  
Susan E. Hickman ◽  
Kathleen T. Unroe ◽  
Mary T. Ersek ◽  
Bryce Buente ◽  
Arif Nazir ◽  
...  
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Interim Analysis ◽  
Care Planning ◽  
Home Setting ◽  
Nursing Home Setting ◽  
Advance Care ◽  
Planning Intervention

scholarly journals PRagmatic trial Of Video Education in Nursing homes: The design and rationale for a pragmatic cluster randomized trial in the nursing home setting

2017 ◽  
Vol 14 (2) ◽  
pp. 140-151 ◽  
Author(s):  
Vincent Mor ◽  
Angelo E Volandes ◽  
Roee Gutman ◽  
Constantine Gatsonis ◽  
Susan L Mitchell
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Advance Care Planning ◽  
Pragmatic Trial ◽  
Healthcare Systems ◽  
Care Planning ◽  
Home Setting ◽  
Randomized Controlled ◽  
Advance Care ◽  
Video Education

Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the “real world” application of an Advance Care Planning Video Program in two large US nursing home healthcare systems. Methods PRagmatic trial Of Video Education in Nursing homes was conducted in 360 nursing homes (N = 119 intervention/N = 241 control) owned by two healthcare systems. Over an 18-month implementation period, intervention facilities were instructed to offer the Advance Care Planning Video Program to all patients. Control facilities employed usual advance care planning practices. Patient characteristics and outcomes were ascertained from Medicare Claims, Minimum Data Set assessments, and facility electronic medical record data. Intervention adherence was measured using a Video Status Report embedded into electronic medical record systems. The primary outcome was the number of hospitalizations/person-day alive among long-stay patients with advanced dementia or cardiopulmonary disease. The rationale for the approaches to facility randomization and recruitment, intervention implementation, population selection, data acquisition, regulatory issues, and statistical analyses are discussed. Results The large number of well-characterized candidate facilities enabled several unique design features including stratification on historical hospitalization rates, randomization prior to recruitment, and 2:1 control to intervention facilities ratio. Strong endorsement from corporate leadership made randomization prior to recruitment feasible with 100% participation of facilities randomized to the intervention arm. Critical regulatory issues included minimal risk determination, waiver of informed consent, and determination that nursing home providers were not engaged in human subjects research. Intervention training and implementation were initiated on 5 January 2016 using corporate infrastructures for new program roll-out guided by standardized training elements designed by the research team. Video Status Reports in facilities’ electronic medical records permitted “real-time” adherence monitoring and corrective actions. The Centers for Medicare and Medicaid Services Virtual Research Data Center allowed for rapid outcomes ascertainment. Conclusion We must rigorously evaluate interventions to deliver more patient-focused care to an increasingly frail nursing home population. Video decision support is a practical approach to improve advance care planning. PRagmatic trial Of Video Education in Nursing homes has the potential to promote goal-directed care among millions of older Americans in nursing homes and establish a methodology for future pragmatic randomized controlled trials in this complex healthcare setting.

scholarly journals Shared decision-making in advance care planning for persons with dementia in nursing homes: a cross-sectional study.

2020 ◽  
Author(s):  
Bart Goossens ◽  
Aline Sevenants ◽  
Anja Declercq ◽  
Chantal Van Audenhove
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Daily Practice ◽  
Care Planning ◽  
Shared Decision ◽  
Cross Sectional ◽  
Advance Care ◽  
Practice Methods

Abstract Background: Shared decision-making provides an approach to discuss advance care planning in a participative and informed manner, embodying the principles of person-centered care. A number of guided approaches to achieve shared decision-making already exist, such as the three-talk model. However, it is uncertain whether daily practice methods in nursing home wards for persons with dementia comply with the underpinnings of this model. It is also uncertain whether professionals consider shared decision-making to be important in this context, and whether they perceive themselves sufficiently competent to practice this approach frequently. Methods: The study has a cross-sectional design, with 65 wards (46 Belgian nursing homes) participating in the study. We compared nursing home professionals’ and residents’ perspectives on the level of shared decision-making during advance care planning conversations with ratings from external raters. Residents and professionals rated the level of shared decision-making by means of a questionnaire, which included the topic of the conversation. External raters assessed audio recordings of the conversations. Professionals filled in an additional self-report questionnaire on the importance of shared decision-making, their competence in practicing the approach, and with what frequency.Results: At ward level, professionals and residents rated the average achieved level of shared decision-making 71.53/100 (σ=16.09) and 81.11/100 (σ=19.18) respectively. Meanwhile, raters gave average scores of 26.97/100 (σ=10.45). Only 23.8% of residents referred to advance care planning as the topic of the conversation. Professionals considered shared decision-making to be important (x̄=4.48/5, σ=0.26). This result contrasted significantly with the frequency (x̄=3.48/5, σ=0.51) and competence (x̄=3.76/5, σ=0.27) with which these skills were practiced (P<0.001).Conclusions: Residents with dementia are grateful when involved in discussing their care, but find it difficult to report what is discussed during these conversations. Receiving more information about advance care planning could provide them with the knowledge needed to prepare for such a conversation. External raters observe a discrepancy between the three-talk model and daily practice methods. Training programs should focus on providing professionals with better knowledge of and skills for shared decision-making. They should also promote team-based collaboration to increase the level of person-centered care in nursing home wards for persons with dementia.

scholarly journals Shared decision-making in advance care planning for persons with dementia in nursing homes: a cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bart Goossens ◽  
Aline Sevenants ◽  
Anja Declercq ◽  
Chantal Van Audenhove
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Daily Practice ◽  
Care Planning ◽  
Shared Decision ◽  
Cross Sectional ◽  
Advance Care ◽  
Practice Methods

Abstract Background Shared decision-making provides an approach to discuss advance care planning in a participative and informed manner, embodying the principles of person-centered care. A number of guided approaches to achieve shared decision-making already exist, such as the three-talk model. However, it is uncertain whether daily practice methods in nursing home wards for persons with dementia comply with the underpinnings of this model. It is also uncertain whether professionals consider shared decision-making to be important in this context, and whether they perceive themselves sufficiently competent to practice this approach frequently. Methods The study has a cross-sectional design, with 65 wards (46 Belgian nursing homes) participating in the study. We compared nursing home professionals’ and residents’ perspectives on the level of shared decision-making during advance care planning conversations with ratings from external raters. Residents and professionals rated the level of shared decision-making by means of a questionnaire, which included the topic of the conversation. External raters assessed audio recordings of the conversations. Professionals filled in an additional self-report questionnaire on the importance of shared decision-making, their competence in practicing the approach, and with what frequency. Results At ward level, professionals and residents rated the average achieved level of shared decision-making 71.53/100 (σ = 16.09) and 81.11/100 (σ = 19.18) respectively. Meanwhile, raters gave average scores of 26.97/100 (σ = 10.45). Only 23.8% of residents referred to advance care planning as the topic of the conversation. Professionals considered shared decision-making to be important (x̄=4.48/5, σ = 0.26). This result contrasted significantly with the frequency (x̄=3.48/5, σ = 0.51) and competence (x̄=3.76/5, σ = 0.27) with which these skills were practiced (P < 0.001). Conclusions Residents with dementia are grateful when involved in discussing their care, but find it difficult to report what is discussed during these conversations. Receiving more information about advance care planning could provide them with the knowledge needed to prepare for such a conversation. External raters observe a discrepancy between the three-talk model and daily practice methods. Training programs should focus on providing professionals with better knowledge of and skills for shared decision-making. They should also promote team-based collaboration to increase the level of person-centered care in nursing home wards for persons with dementia.

scholarly journals Shared decision-making in advance care planning for persons with dementia in nursing homes: a cross-sectional study

2019 ◽  
Author(s):  
Bart Goossens ◽  
Aline Sevenants ◽  
Anja Declercq ◽  
Chantal Van Audenhove
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Daily Practice ◽  
Care Planning ◽  
Shared Decision ◽  
Cross Sectional ◽  
Advance Care ◽  
Practice Methods

Abstract Background Shared decision-making provides an approach to discuss advance care planning in a participative and informed manner, embodying the principles of person-centered care. A number of guided approaches to achieve shared decision-making already exist, such as the three-talk model. However, it is uncertain whether daily practice methods in nursing home wards for persons with dementia comply with the underpinnings of this model. It is also uncertain whether professionals consider shared decision-making to be important in this context, and whether they perceive themselves sufficiently competent to practice this approach frequently.Methods The study has a cross-sectional design, with 65 wards (46 Belgian nursing homes) participating in the study. We compared nursing home professionals’ and residents’ perspectives on the level of shared decision-making during advance care planning conversations with ratings from external raters. Residents and professionals rated the level of shared decision-making by means of a questionnaire, which included the topic of the conversation. External raters assessed audio recordings of the conversations. Professionals filled in an additional self-report questionnaire on the importance of shared decision-making, their competence in practicing the approach, and with what frequency.Results At ward level, professionals and residents rated the average achieved level of shared decision-making 71.53/100 (σ=16.09) and 81.11/100 (σ=19.18) respectively. Meanwhile, raters gave average scores of 26.97/100 (σ=10.45). Only 23.8% of residents referred to advance care planning as the topic of the conversation. Professionals considered shared decision-making to be important (x̄=4.48/5, σ=0.26). This result contrasted significantly with the frequency (x̄=3.48/5, σ=0.51) and competence (x̄=3.76/5, σ=0.27) with which these skills were practiced (P<0.001).Conclusions Residents with dementia are grateful when involved in discussing their care, but find it difficult to report what is discussed during these conversations. Receiving more information about advance care planning could provide them with the knowledge needed to prepare for such a conversation. External raters observe a discrepancy between the tree-talk model and daily practice methods. Training programs should focus on providing professionals with better knowledge of and skills for shared decision-making. They should also promote team-based collaboration to increase the level of person-centered care in nursing home wards for persons with dementia.

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