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Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers

Authors Sævareid TJL, Førde R, Thoresen L, Lillemoen L, Pedersen R

Received 29 January 2019

Accepted for publication 18 April 2019

Published 29 May 2019 Volume 2019:14 Pages 997—1005

DOI https://doi.org/10.2147/CIA.S203298

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Richard Walker


Trygve Johannes Lereim Sævareid,1 Reidun Førde,1 Lisbeth Thoresen,1,2 Lillian Lillemoen,1 Reidar Pedersen1

1Centre for Medical Ethics, University of Oslo, Oslo, Norway; 2Department of Health Sciences, University of Oslo, Oslo, Norway

Purpose: Advance care planning (ACP) performed by regular staff, which also includes patients with cognitive impairment and their next of kin, is scarcely studied. Thus, we planned an implementation study including key stakeholders (patients, next of kin, and health care personnel) using a whole-ward/system approach to ACP. We explored how they experienced ACP and its significance.
Patients and methods: This qualitative study is part of a mixed-method implementation study of ACP. In four nursing homes, we did qualitative interviews and audio-recordings of meetings. We completed 20 individual semistructured interviews with participants soon after ACP conversations. The interviews included patients with cognitive impairment, their next of kin, and health care personnel. We also conducted four focus group interviews with staff and managers in the nursing homes and audio-recorded four network meetings with the project teams implementing ACP.
Results: All participants appreciated taking part in ACP. Patients and next of kin focused more on the past and present than future treatment preferences. Still, ACP seemed to contribute to a stronger patient focus on end-of-life conversations. More generally, ACP seemed to contribute to valuable information for future decision-making, trusting relations, improved end-of-life communication, and saving time and resources.
Conclusion: Safeguarding a strong patient focus on ACP and fostering a person-centered care culture in nursing home wards seem to be achievable through implementation of ACP that includes regular staff, patients with cognitive impairment, and their next of kin.

Keywords: qualitative, person-centered care, whole-system approach, implementation, cognitive impairment


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