Advance Care Planning in Dutch Nursing Homes During the First Wave of the COVID-19 Pandemic

Bastiaan P.H Ter Brugge,Martin Smalbrugge,Margo H Douma,Mieke B Van Der Ploeg,Jelle E Hoeksma,Nienke Fleuren,Vera A Van Atteveld,Eefje M Sizoo

doi:10.1016/j.jamda.2021.10.014

Abstract

ObjectivesTo explore how physicians in Dutch nursing homes practiced advance care planning (ACP) during the first wave of the COVID-19 pandemic, and to explore whether and how ACP changed during the first wave of the pandemic.DesignQualitative analysis of an online, mainly open-ended questionnaire on ACP among physicians working in nursing homes in the Netherlands during the first wave of the COVID-19 pandemic.Setting and ParticipantsPhysicians in Dutch nursing homes.MethodsRespondents were asked to describe a recent case in which they had a discussion on anticipatory medical care decisions and to indicate whether ACP was influenced by the COVID-19 pandemic in that specific case and in general. Answers were independently coded and a codebook was compiled in which the codes were ordered by themes that emerged from the data.ResultsA total of 129 questionnaires were filled out. Saturation was reached after analyzing 60 questionnaires. Four main themes evolved after coding the questionnaires: reasons for ACP discussion, discussing ACP, topics discussed in ACP, and decision making in ACP. COVID-19–specific changes in ACP indicated by respondents included (1) COVID-19 infection as a reason for initiating ACP, (2) a higher frequency of ACP discussions, (3) less face-to-face contact with surrogate decision makers, and (4) intensive care unit admission as an additional topic in anticipatory medical decision making.Conclusions and ImplicationsACP in Dutch nursing homes has changed because of the COVID-19 pandemic. Maintaining frequent and informal contact with surrogate decision makers fosters mutual understanding and aids the decision-making process in ACP.

Highlights

We designed a questionnaire on how physicians in Dutch nursing homes practiced advance care planning (ACP) discussions during the first wave of the COVID-19 pandemic and whether and how this had changed by the pandemic
Four themes emerged from the data: (1) reasons for ACP discussion, (2) discussing ACP, (3) topics discussed in ACP, and (4) decision making in ACP, in which both continuity and change due to the COVID-19 pandemic were mentioned
The topics discussed in ACP were expanded with intensive care unit (ICU) admission and specific policies in case of COVID-19 infection

Summary

Objectives

To explore how physicians in Dutch nursing homes practiced advance care planning (ACP) during the first wave of the COVID-19 pandemic, and to explore whether and how ACP changed during the first wave of the pandemic. Methods: Respondents were asked to describe a recent case in which they had a discussion on anticipatory medical care decisions and to indicate whether ACP was influenced by the COVID-19 pandemic in that specific case and in general. Four main themes evolved after coding the questionnaires: reasons for ACP discussion, discussing ACP, topics discussed in ACP, and decision making in ACP. COVID-19especific changes in ACP indicated by respondents included (1) COVID-19 infection as a reason for initiating ACP, (2) a higher frequency of ACP discussions, (3) less face-to-face contact with surrogate decision makers, and (4) intensive care unit admission as an additional topic in anticipatory medical decision making.

Methods

Discussion

Conclusion