Improving advance care planning in patients with dementia: the effect of training nurses to engage in ACP-related conversations

Abstract

© 2017, Asia Pacific League of Clinical Gerontology & Geriatrics. Background: Advance care planning consists of an individual approach to anticipate the decisions on treatment during the course of illness and at the end of life. In a nursing home setting there is a pressing need for advance care planning, especially for residents with dementia. Timely discussion of the treatment goals may help to increases the resident’s autonomy and the quality of life and care. Objectives: The aim of the study is to assess the effect of an education program for nurses on the registration of care goals in a nursing home with a population of elderly residents suffering from dementia. Another objective was to explore the views of nursing home staff on advance care planning in patients with dementia. Methods: This quantitative study is a pre-and post-intervention evaluation in a nursing home in Flanders, Belgium, providing care for a population of 124 residents diagnosed with dementia. The intervention consisted of a 12-month program for nursing staff (n=13) including training in theoretical and communication skills. This group was asked to complete a structured 10-item-questionnaire (type Likert) at 0 and 12 months between January 2011 and January 2012 exploring their views on facilitating and obstructing factors concerning the implementation of ACP. At the same time a pre-and post-measurement of all ACP-related registrations, based on a novel care goals model in the electronic medical record was done. Results: The intervention included all 124 residents diagnosed with dementia. 13 members of the nursing staff participated in the training and completed the questionnaire at point 0 and 12 months. At 12 months we noticed a significant increase in the number of interviews regarding ACP held with the residents, and also a significant increase in the number of care goals documented. We identified several facilitating factors and barriers for the ACP process. Furthermore we saw significant changes in caregiver’s views on ACP at the end of the intervention period. Conclusions: Prior to the intervention the members of the nursing staff presented some resistance towards the implementation of ACP, supported the ACP process afterwards. ACP was said to help raise the dignity and autonomy of the residents, and was especially useful in improving clarity for medical decision making. The number of successfully recorded information on ACP was increased significantly. Special attention should be given to the barriers that obstruct the implementation of ACP in the nursing home setting.