Advance care planning for home health staff: a systematic review

Background Advance care planning (ACP) is a process where patients express their wishes regarding their future healthcare. Its importance has been increasingly recognised in the past decade. As increasing numbers of elderly people are living in care homes, the aim of this review was to identify the most effective ACP interventions to train/educate all levels of healthcare professionals working in care homes. Design A systematic review. Two independent reviewers undertook screening, data extraction and quality assessment. Data sources Searched from inception to June 2018: Ovid Medline, Ovid Medline in process, Ovid Embase, Cochrane Central Register of Controlled Trials, EBSCO Cinahl and Ovid PsycINFO. Results Six studies were included: three before and after studies, one cluster randomised controlled trial (RCT), one non-blinded RCT and one qualitative study. Five studies reported on ACP documentation, three on impact on ACP practice and three studies on healthcare-related outcomes. All quantitative studies reported an improvement in outcomes. In the three studies reporting on health-related outcomes, one showed significant reductions in hospitalisation rate, days and healthcare costs; one reported significant reductions in hospital deaths; and the third showed reductions in hospital days and deaths. A meta-analysis could not be performed due to the heterogeneity of the outcome measures. The included qualitative study highlighted perceived challenges to implementing an educational programme in the care home setting. Conclusion There is limited evidence for the effectiveness of ACP training for care home workers. More well-designed studies are needed. Trial registration number CRD42016042385.

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Experience of use of advance care planning in care homes

10.1093/oso/9780198802136.003.0012 ◽

2018 ◽

Author(s):

Maggie Stobbart-Rowlands ◽

Mandy Thorn

Keyword(s):

Advance Care Planning ◽

Best Practice ◽

Care Home ◽

Training Programme ◽

Best Interests ◽

Care Homes ◽

Care Planning ◽

Home Setting ◽

People With Dementia ◽

Advance Care

This chapter describes the care home setting, aspects that have an impact on use of Advance care planning (ACP) in care homes, examples of challenges and best practice, use of ACP in the GSF Care Homes Training Programme, ACP with people with dementia, and culture change. Many people in care homes are in the last year/s of life, and ACP discussions are especially important for them to ensure that the care they receive is in line with what they want. Care homes lead the way in their extensive use of ACP discussions. ACP is more routinely used by care home staff than is often recognized, and can be easier to introduce in care homes than in other settings. Key challenges include poor means of communication due to dementia/cognitive impairment or physical deterioration, and how staff address the expectations of families, and ensure any interventions are in the best interests of the person.

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Facilitators and barriers to advance care planning programmes targeting older care home residents: a qualitative study

10.12809/ajgg-2018-326-oa ◽

2020 ◽

Vol 14 (2) ◽

pp. 81-88

Author(s):

Bobo Hi-Po Lau ◽

James KH Luk ◽

Candy HC Fong ◽

Amy YM Chow ◽

Cecilia LW Chan ◽

...

Keyword(s):

Qualitative Study ◽

Advance Care Planning ◽

Care Home ◽

Care Planning ◽

Advance Care ◽

Facilitators And Barriers

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Palliative care service utilization and advance care planning issues for adult glioblastoma patients: A systematic review.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.2036 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 2036-2036

Author(s):

Adela Wu ◽

Gabriela Ruiz Colon ◽

Rebecca Aslakson ◽

Erqi L. Pollom ◽

Chirag B Patel

Keyword(s):

Systematic Review ◽

Palliative Care ◽

End Of Life ◽

Advance Care Planning ◽

Cochrane Library ◽

Care Planning ◽

Inclusion Criteria ◽

Financial Barriers ◽

Home Setting ◽

Advance Care

2036 Background: Glioblastoma (GBM) is a devastating disease with a median survival under 2 years and a 10-year survival rate of 0.71%. As patients with GBM suffer simultaneously from both a terminal cancer and a neurodegenerative disease, proactive provision of advance care planning (ACP) and palliative care (PC) seem appropriate. We conducted a systematic review exploring the published literature on the prevalence of ACP, healthcare services utilization at the end of life (EOL, including PC services), and location of death among adults with GBM, and the experiences of their caregivers. Methods: We systematically searched PubMed, Embase, Scopus, and Cochrane Library from database inception until 12/20/2020, using search terms including ‘glioblastoma’, ‘end of life’, ‘advance care planning’, and ‘advance directive’. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Inclusion criteria were quantitative and qualitative studies written in English of adults with GBM and their caregivers, with at least 20 subjects. Included studies were assessed for quality using the Newcastle-Ottawa Scale. Results: We screened 344 article abstracts and 39 full text articles to yield a final cohort of 16 articles that fit inclusion criteria. These studies reported the experiences of 10,706 GBM patients and 123 caregivers. All were nonrandomized studies conducted in six countries with all but two published in 2014 or later. Across studies, ACP documentation varied from 4-55%, PC referral was pursued in 39-40% of cases, and hospice referrals were made for 66-76% of adult GBM patients. Hospitalizations frequently occurred at the EOL, 20-56% of patients spent over 25% of their overall survival time hospitalized, and 39-64 % of deaths occurred in the home setting. Caregivers commonly reported restrictions on their ability to work (60%), financial barriers to care (29%), and feeling unprepared (29%). Conclusions: Despite having both a terminal disease and neurocognitive decline, a majority of adults with GBM do not pursue ACP or have access to PC. There is a dearth of focused and high-quality studies on ACP, PC, and hospice use among adults with GBM. Prospective studies that address these and additional aspects related to end-of-life care in this population, such as healthcare costs and inpatient supportive care needs, are needed.

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A critical realist evaluation of advance care planning in care homes

Journal of Advanced Nursing ◽

10.1111/jan.14822 ◽

2021 ◽

Author(s):

Adam Spacey ◽

Janet Scammell ◽

Michele Board ◽

Sam Porter

Keyword(s):

Advance Care Planning ◽

Realist Evaluation ◽

Care Homes ◽

Care Planning ◽

Critical Realist ◽

Advance Care

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Conducting an advance care planning group among older adults living in residential care homes: An initiative of social workers in Hong Kong

Health & Social Care in the Community ◽

10.1111/hsc.13310 ◽

2021 ◽

Author(s):

Wallace Chi Ho Chan ◽

Tsz Kiu Yu

Keyword(s):

Older Adults ◽

Hong Kong ◽

Social Workers ◽

Residential Care ◽

Advance Care Planning ◽

Care Homes ◽

Care Planning ◽

Advance Care ◽

Planning Group

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PRagmatic trial Of Video Education in Nursing homes: The design and rationale for a pragmatic cluster randomized trial in the nursing home setting

Clinical Trials ◽

10.1177/1740774516685298 ◽

2017 ◽

Vol 14 (2) ◽

pp. 140-151 ◽

Cited By ~ 21

Author(s):

Vincent Mor ◽

Angelo E Volandes ◽

Roee Gutman ◽

Constantine Gatsonis ◽

Susan L Mitchell

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Advance Care Planning ◽

Pragmatic Trial ◽

Healthcare Systems ◽

Care Planning ◽

Home Setting ◽

Randomized Controlled ◽

Advance Care ◽

Video Education

Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the “real world” application of an Advance Care Planning Video Program in two large US nursing home healthcare systems. Methods PRagmatic trial Of Video Education in Nursing homes was conducted in 360 nursing homes (N = 119 intervention/N = 241 control) owned by two healthcare systems. Over an 18-month implementation period, intervention facilities were instructed to offer the Advance Care Planning Video Program to all patients. Control facilities employed usual advance care planning practices. Patient characteristics and outcomes were ascertained from Medicare Claims, Minimum Data Set assessments, and facility electronic medical record data. Intervention adherence was measured using a Video Status Report embedded into electronic medical record systems. The primary outcome was the number of hospitalizations/person-day alive among long-stay patients with advanced dementia or cardiopulmonary disease. The rationale for the approaches to facility randomization and recruitment, intervention implementation, population selection, data acquisition, regulatory issues, and statistical analyses are discussed. Results The large number of well-characterized candidate facilities enabled several unique design features including stratification on historical hospitalization rates, randomization prior to recruitment, and 2:1 control to intervention facilities ratio. Strong endorsement from corporate leadership made randomization prior to recruitment feasible with 100% participation of facilities randomized to the intervention arm. Critical regulatory issues included minimal risk determination, waiver of informed consent, and determination that nursing home providers were not engaged in human subjects research. Intervention training and implementation were initiated on 5 January 2016 using corporate infrastructures for new program roll-out guided by standardized training elements designed by the research team. Video Status Reports in facilities’ electronic medical records permitted “real-time” adherence monitoring and corrective actions. The Centers for Medicare and Medicaid Services Virtual Research Data Center allowed for rapid outcomes ascertainment. Conclusion We must rigorously evaluate interventions to deliver more patient-focused care to an increasingly frail nursing home population. Video decision support is a practical approach to improve advance care planning. PRagmatic trial Of Video Education in Nursing homes has the potential to promote goal-directed care among millions of older Americans in nursing homes and establish a methodology for future pragmatic randomized controlled trials in this complex healthcare setting.

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