A review of the implementation and research strategies of advance care planning in nursing homes

BMC Geriatrics

Research Article

B. S. Husebo¹  E. Flo¹  L. Thoresen²  P. Bruusgaard²  L. Lillemoen²  R. Pedersen²  E. Gjerberg² 

[1] Centre for Elderly-and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box: 7200, Bergen, Norway;Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway;

关键词: Advance care planning;    Nursing home;    Dementia;    End-of-life care;    Implementation;    Barriers;    Ethical decision making;   

DOI  :  10.1186/s12877-016-0179-4

 received in 2015-07-17, accepted in 2016-01-04,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundNursing home (NH) patients have complex health problems, disabilities and needs for Advance Care Planning (ACP). The implementation of ACP in NHs is a neglected research topic, yet it may optimize the intervention efficacy, or provide explanations for low efficacy. This scoping review investigates methods, design and outcomes and the implementation of ACP (i.e., themes and guiding questions, setting, facilitators, implementers, and promoters/barriers).MethodsA systematic search using ACP MESH terms and keywords was conducted in CINAHL, Medline, PsychINFO, Embase and Cochrane libraries. We excluded studies on home-dwelling and hospital patients, including only specific diagnoses and/or chart-based interventions without conversations.ResultsSixteen papers were included. There were large variations in definitions and content of ACP, study design, implementation strategies and outcomes. Often, the ACP intervention or implementation processes were not described in detail. Few studies included patients lacking decision-making capacity, despite the fact that this group is significantly present in most NHs. The chief ACP implementation strategy was education of staff. Among others, ACP improved documentation of and adherence to preferences. Important implementation barriers were non-attending NH physicians, legal challenges and reluctance to participate among personnel and relatives.ConclusionACP intervention studies in NHs are few and heterogeneous. Variation in ACP definitions may be related to cultural and legal differences. This variation, along with sparse information about procedures, makes it difficult to collate and compare research results. Essential implementation considerations relate to the involvement and education of nurses, physicians and leaders.

【 授权许可】

CC BY   
© Flo et al. 2016