Abstract
ObjectivesDespite known benefits, advance care planning (ACP) is rarely a component of usual practice in long-term care (LTC). A series of tools and workbooks have been developed to support ACP uptake amongst the generable population. Yet, their potential for improving ACP uptake in LTC has yet to be examined. This study explored if available ACP tools are acceptable for use in LTC by (a) eliciting staff views on the content and format that would support ACP tool usability in LTC (b) examining if publicly available ACP tools include content identified as relevant by LTC home staff. Ultimately this study aimed to identify the potential for existing ACP tools to improve ACP engagement in LTC.MethodsA combination of focus group deliberations with LTC home staff (N = 32) and content analysis of publicly available ACP tools (N = 32) were used to meet the study aims.ResultsFocus group deliberations suggested that publicly available ACP tools may be acceptable for use in LTC if the tools include psychosocial elements and paper-based versions exist. Content analysis of available paper-based tools revealed that only a handful of ACP tools (32/611, 5%) include psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%).ConclusionsACP tools that include psychosocial content may improve ACP uptake in LTC because they elicit future care issues considered pertinent and can be supported by a range of clinical and non-clinical staff. To increase usability and engagement ACP tools may require infusion of scenarios pertinent to frail older persons, and a better balance between psychosocial content that elicits reflections and psychosocial content that supports communication.
Highlights
Long-Term-Care (LTC) homes are a major site of death for older adults globally [1, 2]
Focus group deliberations suggested that publicly available Advance care planning (ACP) tools may be acceptable for use in LTC if the tools include psychosocial elements and paper-based versions exist
Content analysis of available paper-based tools revealed that only a handful of ACP tools (32/611, 5%) include psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%)
Summary
Long-Term-Care (LTC) homes are a major site of death for older adults globally [1, 2]. Advance care planning (ACP) is an important component of a comprehensive palliative approach program because it empowers individuals with non-reversible health conditions to reflect on, communicate, and sometimes document their values, beliefs, and preferences for future end of life care [5, 6]. ACP programs that include multiple steps have shown some successful outcomes in increasing ACP engagement in LTC [13] Such programs typically offer direction to clinicians around making people aware of ACP (e.g. how to explain what ACP is, what it involves and why it is important), facilitating ACP conversations (e.g. questions to ask to elicit personal preferences for care, values and wishes that may guide future decisions) and mechanisms to help people identify what to communicate to others such as family or appointed decision-makers [21]. ACP materials that do not heavily rely on clinical staff for facilitation may go a long way in improving ACP uptake in LTC [24]
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