The experience of advance care planning discussion among older residents in a long-term care institution: A qualitative study.

Abstract

To explore the experiences and processes of advance care planning (ACP) discussions in older residents of a long-term care institution. Advance care planning can facilitate discussion about end-of-life care and help to identify individual's views, wishes and beliefs about dying at a time when they have the cognitive capacity to reflect on and/or make such decisions. A qualitative study was conducted. Twenty-eight older adults in a long-term care institution participated in person-to-person interviews using an ACP booklet, which included topics such as life review, healthy habits and behaviours, and end-of-life care issues and information. The discussions were recorded, and thematic analysis was used to analyse the qualitative data. The Standards for Reporting Qualitative Research (SRQR) checklist was followed. Three themes were identified. First, participants identified that ACP could help to ensure that they achieved their view of a "good death." Second, the process of ACP bought up difficult decisions that many participants expressed uncertainty about making. Third, participants' ability and willingness to plan for end of life were shaped by considerations about their family members' needs, views and potential role as their future carer. The ACP process involved not only personal ideas about good death but also families' concerns. Uncertainty and lack of information created difficult barriers. Healthcare professionals could address the concept of good death, deliver information for their concerns and promote communication with family members.