Family Meetings: Impact on Length of Stay and Disposition (710)

Abstract

3. Discuss the lessons learned from cancer family members that can be applied to family members of nursing home residents with organ failure and/or frailty. I. Background. With a higher percentage of people living long enough to die in old age, our society is faced with learning how to care for older adults dying in the context of advanced chronic illness, especially in nursing homes. Because of the declining cognitive capacity of many NH residents, family members are often involved in medical decision-making. The aim of the study is to learn about decision-making from the perspective of family members of residents with cancer. II. Research Objectives. (i) Describe the context of medical decision-making faced by family members of nursing home residents with cancer; and (ii) Describe the factors that family members use to develop their reference point for decision-making. III. Methods. Participants were recruited from 3 NH with the help of staff and flyers. Each participant was interviewed at least once (in-person or phone), and a third were interviewed a second time 8 months later. Interviews lasted from 1e3 hours, were tape recorded, and transcribed verbatim. To conduct the content analysis, a coding scheme was developed after reading the first three transcripts and applied to all interviews with the help of NVIVO software. Once the preliminary findings were developed, the research team recognized that Prospect Theory would provide a useful backdrop to make sense of the findings. IV. Results. The 24 respondents included spouses, adult children, and nephews: 1. The context was dominated by psychosocial issues affecting the resident. 2. For most of the NH residents, this was not their first cancer. Many had already lived longer than anticipated, on borrowed time, and had expressed to their family members their lack of interest in burdensome l interventions. 3. How family members frame the health and social status of their loved one can affect the extent to which medical interventions and which interventions are pursued. I. Conclusion. Preliminary findings indicate that having faced previous cancer diagnoses can affect decision-making reference points for both residents and family members in favor of comfort care. II. Implications for Research, Policy, or Practice. Clinical conversations about medical decision-making should include questions about the patients and family members’ reference points as this can affect how decision-makers weigh care options. Reference points may change based on information provided by the physician. Further research is needed to determine if different dying trajectories are accompanied by different reference points.