Abstract
Introduction: The majority of nursing home (NH) patients suffer from complex diseases, including dementia. This makes advance care planning (ACP) particularly important.Objectives: The aim was to investigate the effect of an ACP intervention on communication among NH staff, patient, and family. We further investigated whether the intervention affected nursing staff distress.Methods: The ACP intervention was a part of the 4-month cluster randomized controlled COSMOS trial with a 9-month follow-up. Norwegian NH units (n = 72), with 765 patients were invited, and eligible units were cluster randomized to usual care or the intervention group. The ACP intervention consisted of an education program targeting all NH staff (nurses and physicians) and managers. Implementation was supported by a train-the-trainer approach, with regular phone calls from the researchers. The effect of the intervention was assessed by a data collection form and questionnaires. Nursing staff distress was assessed by the Neuropsychiatric Inventory -Nursing Home version.Results: Five hundred and forty five patients from 67 NH units were included and randomized to the intervention (N = 297; 36 units) and control group (N = 248; 31 units). Organized meetings between the family, patient, and nurses were conducted more frequently in the intervention compared to the control group at month 4 (OR = 3.9, 95% CI = 1.6 to 9.4, p = 0.002). Monthly contact between family and nurses was also more frequent in the intervention group (OR = 6.5, 95% CI = 1.6 to 3.5, p = 0.010). Nurses and families were more satisfied with their communication in the intervention compared to the control group. Staff distress was reduced in the intervention group at month 4 (B = -1.8, 95% CI = -3.1 to -0.4, p = 0.012). The intervention effect at month 4 did not persist during follow-up at month 9.Conclusion: Compared to control, the ACP intervention improved the communication, and family and staff satisfaction as well as reduced staff distress. However, during the follow-up period these positive effects were not persistent. Indicating the necessity for ongoing staff support regarding ACP.Trial Registration: www.ClinicalTrials.gov (NCT02238652).
Highlights
The majority of nursing home (NH) patients suffer from complex diseases, including dementia
There were no significant differences between key patient characteristics (Table 2) or any of the other outcomes apart from more invitations to conversations with the NH physician reported in the intervention group (n = 28, 19%) compared to the control group (n = 15, 11%), p = 0.05 (Table 3)
We found a reduction in nursing staff distress in the intervention as compared to the control group at month 4 (B = −1.8, 95% CI = −3.1 to −0.4, p = 0.012) assessed by NPINH distress scale (Table 5)
Summary
The majority of nursing home (NH) patients suffer from complex diseases, including dementia This makes advance care planning (ACP) important. Advance care planning (ACP) is an ongoing process of communication between healthcare providers, the patient and the family to clarify their understanding, wishes, values, and potential concerns about treatment and care at the end of life (Detering et al, 2010; Flo et al, 2016; Rietjens et al, 2017). In a current Irish feasibility study including 290 long-term care and community hospital patients, McGlade et al (2017) reported that more than 50% completed an end-of-life care plan, despite the reluctance of some nurses to participate in the ACP process because they thought of it as the responsibility of the NH managers (McGlade et al, 2017). Though family involvement is essential, previous studies have shown that patients and relatives rely on health personnel to initiate this type of communication (Fosse et al, 2014)
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