Journal
CANADIAN JOURNAL ON AGING-REVUE CANADIENNE DU VIEILLISSEMENT
Volume 41, Issue 1, Pages 110-120Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0714980820000410
Keywords
aging; nursing homes; advanced care planning; best practices; end of life; consent; comfort care
Categories
Funding
- Canadian Frailty Network [TG2015-15]
- Research Manitoba
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Long term care (LTC) residents facing the end of life often experience unmet needs and unnecessary hospital transfers, highlighting the inadequacy of advance care planning (ACP). A workshop was conducted to identify shared barriers and solutions to improve ACP and end-of-life care for LTC residents, with the results informing the development of a standardized ACP intervention being evaluated in three Canadian provinces.
As they near the end of life, long term care (LTC) residents often experience unmet needs and unnecessary hospital transfers, a reflection of suboptimal advance care planning (ACP). We applied the knowledge-to-action framework to identify shared barriers and solutions to ultimately improve the process of ACP and improve end-of-life care for LTC residents. We held a 1-day workshop for LTC residents, families, directors/administrators, ethicists, and clinicians from Manitoba, Alberta, and Ontario. The workshop aimed to identify: (1) shared understandings of ACP, (2) barriers to respecting resident wishes, and (3) solutions to better respect resident wishes. Plenary and group sessions were recorded and thematic analysis was performed. We identified four themes: (1) differing provincial frameworks, (2) shared challenges, (3) knowledge products, and 4) ongoing ACP. Theme 2 had four subthemes: (i) lacking clarity on substitute decision maker (SDM) identity, (ii) lacking clarity on the SDM role, (iii) failing to share sufficient information when residents formulate care wishes, and (iv) failing to communicate during a health crisis. These results have informed the development of a standardized ACP intervention currently being evaluated in a randomized trial in three Canadian provinces.
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