Discussing advance care planning: insights from older people living in nursing homes and from family members.

ABSTRACTBackground:Evidence concerning when and in which manner older people living in nursing homes (NHs) would prefer to discuss advance care planning (ACP) is still scarce. This study explored the attitudes of NH residents and family members toward ACP and their opinions as to the right time to broach the subject, the manner in which it should be approached, and the content of ACP. METHODS: This was a qualitative study using face-to-face interviews with 30 residents (age range 66-94), and 10 family members from 4 Italian NHs. The interviews were analyzed using content analysis. RESULTS: Three main themes were identified: (1) life in the NH, including thoughts about life in a nursing home, residents' concerns, wishes and fears, and communication barriers; (2) future plans and attitudes toward ACP, including attitudes toward planning for the future and plans already made, and attitudes toward and barriers against ACP; (3) contents and manner of ACP, including contents of ACP discussions, the right moment to introduce ACP, with whom it is better to discuss ACP, and attitudes toward advance directives. CONCLUSIONS: ACP was a welcome intervention for the majority of participants, but an individualized assessment of the person's readiness to be involved in ACP is needed. For people with dementia, it is essential to identify the right time to introduce ACP before NH admission. Participants in our study suggested that ACP should include palliative care and practical issues, and that in the NH setting all staff and family members may have a valuable role in ACP.

Perspectives of older people living in long-term care facilities and of their family members toward advance care planning discussions: a systematic review and thematic synthesis.

OBJECTIVE: We aimed to search and synthesize qualitative studies exploring the perspectives of older people living in long-term care facilities and of their family members about advance care planning (ACP) discussions. METHODS: The enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) framework was used to guide the review and report its results. PubMed, CINAHL, and PsycINFO were searched for studies published between January 2000 and November 2015. All included studies were assessed for comprehensiveness of reporting, and a thematic synthesis of their results was performed. RESULTS: The nine included studies differed in terms of qualitative method used, comprehensiveness of reporting, and geographical origin. The thematic synthesis led to the identification of four main themes: 1) plans already made; 2) end-of-life care and decision-making; 3) opinions and attitudes toward ACP; and 4) how, when, about what, and with whom to do ACP. CONCLUSION: Despite their willingness to be involved in a shared decision-making process, older residents and their families still have little experience with ACP. PRACTICAL IMPLICATIONS: In view of implementing ACP for elders living in long-term care facilities, it would be important to rethink ACP and also to incorporate their nonmedical preferences, according to their own priorities.

I fogli informativi dei trial randomizzati controllati forniscono informazioni chiare?

Do patient information sheets for randomized controlled trial provide clear information? Aim. To assess whether patient information sheets (PIS) for randomized controlled trials (RCT) submitted during 2012 to a large Italian Ethics Committee provided clear information. Methods. One hundred and seven PIS for RCT involving adult subjects were obtained from the Ethics Committee Office. Using a five-point scale, two observers with education in nursing assessed the overall PIS comprehensibility and the clarity of information provided about the following items: rational of the study, aims, procedures, randomization, placebo, blindness, anticipated benefits, potential risks. Two further items focused on whether it was clear who promoted/sponsored the study and that the researcher/hospital would receive a fee/refund by the sponsor (clear/not clear). Results. At least 87% of PIS were rated as sufficiently clear regarding aims, procedures, placebo, potential risks, and who promoted/sponsored the study. Information about fee/refund to researcher/hospital, randomization, rational of the study, blindness, and anticipated benefits was rated as sufficiently clear in 61%, 60%, 53%, 50%, and 29% of PIS respectively. Overall comprehensibility was sufficient for 93% of PIS. Overall agreement between raters was on average 84%. Interobserver reliability was moderate or substantial for most items, and fair for randomization and blindness. Conclusions. Many PIS do not provide clear information about several issues important to allow informed consent, especially regarding anticipated benefits. Nurses may offer consistent opinion in PIS assessment.