%0 Journal Article
%T Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members
%A Kimberly Ramsbottom
%A Mary Lou Kelley
%J International Journal of Palliative Care
%D 2014
%R 10.1155/2014/358457
%X Long term care (LTC) homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP) important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descriptive study conducted 34 individual semistructured interviews in two LTC homes, located in Canada. The participants were 31 family members and three staff, consisting of a front line care worker, a registered nurse, and a nurse practitioner. All participants perceived ACP conversations as valuable to provide ¡°resident-centred care¡±; however, none of the participants had a good understanding of ACP, limiting its effectiveness. Strategies generated through the research to improve ACP were as follows: educating families and staff on ACP and end-of-life care options; better preparing staff for ACP conversations; providing staff skills training and guidelines; and LTC staff initiating systematic, proactive conversations using careful timing. These strategies can guide quality improvement of palliative care and development of ACP tools and resources specific to the LTC home sector. 1. Introduction Long term care (LTC) homes today provide care to people of advanced age, frailty, or disability, with multiple health problems [1, 2]. Increasingly, they provide end-of-life care [3¨C5] as approximately one in five residents living in LTC homes in Canada and UK dies each year [6¨C9]. Yet, there exists a culture of silence surrounding dying that creates a barrier to end-of-life communications in LTC [2, 10]. Lack of discussion with the resident and the resident¡¯s substitute decision-maker, most commonly a family member, about end-of-life wishes can lead to unnecessary and unwanted medical treatments [11, 12], unnecessary transfers to the acute hospital [13], and discomfort and anxiety for both the resident and family [14]. Implementing effective advance care planning (ACP) can improve patient and family satisfaction with care and increase the likelihood that people will die in their setting of choice [12, 15]. Dying at home in the long term care home can be offered as an option during ACP discussions. ACP is a structured conversation to help people decide, communicate, and document their wishes for care at the end of life [16, 17]. ACP is viewed as an essential component of a quality
%U http://www.hindawi.com/journals/ijpc/2014/358457/