ReviewPreconditions for successful advance care planning in nursing homes: A systematic review
Section snippets
Background
Advance care planning (ACP) is a continual, dynamic process of reflection and dialogue between patients, family and care providers concerning preferences and values for future treatment and care including end-of-life care, and is aimed at enhancing the concordance between preferences and actual care or treatments received (Teno, 2003, Gillick, 2004a, Singer et al., 1998, Kolarik et al., 2002, Sudore and Fried, 2010, Ahluwalia and Gordon, 2012). If a patient wishes, the contents of such
Methods
We conducted a systematic review of published literature.
Results
Initial database searches yielded 807 references from our first search and 376 from the second. Reference list screening identified three papers (Shalowitz et al., 2006, Lorenz et al., 2008, Street and Ottmann, 2006).
Domain 1: sufficient knowledge and skills
1. An appropriately skilled health-care professional is available for advance care planning at the facility (Sharp et al., 2013, Morrison et al., 2005, Lorenz et al., 2008, Street and Ottmann, 2006, Ashton et al., 2015, Jeong et al., 2010, Rhee et al., 2013, Stewart et al., 2011, Silvester et al., 2012, Chan and Pang, 2010, Bernacki and Block, 2014, Brinkman-Stoppelenburg et al., 2014a, Ke et al., 2015a, Lovell and Yates, 2014, Lund et al., 2015). It is importance that a health-care
Domain 2: willingness and ability to participate in advance care planning
5. Residents, family and professionals are willing to participate in advance care planning (Sharp et al., 2013, Houben et al., 2014a, Ashton et al., 2015, Black et al., 2009, Chan and Pang, 2011, Chan and Pang, 2010, Dickinson et al., 2013, Hall et al., 2011, Shanley et al., 2009, Stewart et al., 2011, Stone et al., 2013, van Eechoud et al., 2014, Einterz et al., 2014, Brooke and Kirk, 2014, Séchaud et al., 2014, Waldrop and Meeker, 2012, Dening et al., 2011, Ke et al., 2015a, Lovell and Yates,
Domain 3: good relationships
10. There is a good relationship between staff and family and between staff and residents (Addicott, 2011, Ashton et al., 2015, Stewart et al., 2011, Stone et al., 2013, van Eechoud et al., 2014, Einterz et al., 2014, Chan and Pang, 2010, Waldrop and Meeker, 2012, Ke et al., 2015a). Disputes between staff and family is often an important barrier to successful advance care planning (Stewart et al., 2011). Additionally, direct contact between physicians and families in the nursing home setting is
Domain 4: availability of an administrative system for documenting wishes and monitoring care
12. There is a written record of the expressed wishes and preferences that is readable, accessible and clear (Morrison et al., 2005, Street and Ottmann, 2006, Dickinson et al., 2013, Shanley et al., 2009, Reinhardt et al., 2014, Séchaud et al., 2014, Wickson-Griffiths et al., 2014, Lund et al., 2015, Ke et al., 2015b, Robinson et al., 2012b, Houben et al., 2014b). The outcome of advance care planning conversations is often measured by the increase in the number of standardized records or
Domain 5: supportive contextual factors
14. There are sufficient resources and time available for ACP (Sharp et al., 2013, Street and Ottmann, 2006, Ashton et al., 2015, Dickinson et al., 2013, Jeong et al., 2010, Einterz et al., 2014, Chan and Pang, 2010, in der Schmitten et al., 2014, Bernacki and Block, 2014, Brooke and Kirk, 2014, Waldrop and Meeker, 2012, Lovell and Yates, 2014, Lund et al., 2015, Ke et al., 2015b). Inadequate resources, additional costs, lack of time and specific tasks that conflict with other job demands are
Discussion
Based on 38 publications with heterogeneous study designs and primarily moderate methodological quality, we have identified 17 preconditions in five domains. These domains are: 1) sufficient knowledge and skills, 2) willingness and ability to participate in advance care planning, 3) good relationships, 4) availability of an administrative system for documenting wishes and monitoring care, and 5) supportive contextual factors. We also identified the different levels to which each precondition is
Conclusion
This systematic review provides a considerable contribution to the evidence base of preconditions for optimal implementation of advance care planning in the nursing home context. Findings support efforts to improve advance care planning by giving particular attention to health-care professionals and the facility, stipulating that a whole-system approach must be taken. This paper also highlights that a theoretical framework such as the Theory of Change is useful to identify preconditions for
Declaration of conflicting interests
None.
Funding
This work was supported by the Research Foundation − Flanders (FWO).
Ethical approval
None.
Acknowledgements
Conception and design of the study and interpretation of data: all authors. Assistance in data analysis: LP, LVdB, CG and LD. Drafting of the article: JG. Critical revision of the manuscript: all authors. All authors gave final approval of the version to be published and take responsibility for the integrity of the data and the accuracy of the data analysis. Guarantor of the study: LVdB. We thank Katrien Alewaeters and Wolters Kluwer for their support in translating the search string.
References (89)
- et al.
Enhancing patient-Professional communication about end-of-Life issues in life-Limiting conditions: a critical review of the literature
J. Pain. Symptom Manage.
(2012) - et al.
Development and testing of a decision aid on goals of care for advanced dementia
J. Am. Med. Dir. Assoc.
(2014) - et al.
Efficacy of advance care planning: a systematic review and meta-analysis
J. Am. Med. Dir. Assoc.
(2014) - et al.
Efficacy of advance care planning: a systematic review and meta-analysis
J. Am. Med. Dir. Assoc.
(2014) - et al.
Advance care planning in Belgium and The Netherlands: a nationwide retrospective study via sentinel networks of general practitioners
J. Pain Symptom Manage.
(2011) - et al.
End-of-life care in U.S. nursing homes: a review of the evidence
J. Am. Med. Dir. Assoc.
(2004) - et al.
AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews
J. Clin. Epidemiol.
(2009) - et al.
Advance care planning and physician orders in nursing home residents with dementia: a nationwide retrospective study among professional caregivers and relatives
J. Pain Symptom Manage.
(2014) - et al.
Perspectives of family members on planning end-of-Life care for terminally ill and frail older people
J. Pain Symptom Manage.
(2014) - et al.
Communication and advanced care planning in palliative and end-of-life care
Nurs. Outlook
(2012)