Perspectives of Nursing Home Staff in Advance Care Planning Conversations: Experiences from the APPROACHES Project

IF 4.2 2区医学 Q2 GERIATRICS & GERONTOLOGY

Journal of the American Medical Directors Association Pub Date : 2024-09-14 DOI:10.1016/j.jamda.2024.105265

Kathleen T. Unroe MD, MHA, MS , Hillary D. Lum MD, PhD , Susan E. Hickman PhD

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引用次数: 0

Abstract

Objectives

Advance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences – a Role offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP.

Design

Qualitative interviews regarding ACP specialists’ experiences and perceived intervention impact.

Setting and Participants

Staff of intervention-assigned nursing home facilities who completed a minimum of 10 ACP conversations with residents during APPROACHES program implementation.

Methods

Fourteen staff were interviewed. Interviews were transcribed and coded by the research team.

Results

There were 21 codes identified that were then distilled into the following 5 themes: (1) experiences with the ACP specialist program, (2) engaging in ACP conversations, (3) considerations related to dementia, (4) benefits and challenges of ACP, and (5) involvement of multiple people in the ACP process. Participant responses suggested variability in experiences with the ACP specialist program and highlighted many aspects relevant to engaging in conversations with families and residents, particularly those living with dementia. Benefits of ACP, including relationship building and increased preparedness for changes in health status, were balanced with challenges related to sensitive conversation topics and logistical difficulties in scheduling ACP discussions. ACP specialists discussed the multiple roles that others played in the ACP process.

Conclusions and Implications

Findings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.

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养老院工作人员在预先护理计划对话中的观点：APPROACHES 项目的经验。

目标：预先护理计划（ACP）被认为是疗养院环境中的最佳实践；然而，疗养院员工的培训和结构化 ACP 计划的实施缺乏一致性。为了了解参与 APPROACHES（一项旨在改善 ACP 的嵌入式实用临床试验）的员工的经验，我们对养老院的 ACP 专家进行了一项定性研究访谈：设计：就 ACP 专家的经验和感知的干预影响进行定性访谈：在 APPROACHES 项目实施过程中与住院患者进行了至少 10 次 ACP 交谈：对 14 名员工进行了访谈。研究小组对访谈内容进行了转录和编码：共确定了 21 个编码，然后将其提炼为以下 5 个主题：(1) ACP 专家计划的经验，(2) 参与 ACP 对话，(3) 与痴呆症相关的注意事项，(4) ACP 的益处和挑战，以及 (5) ACP 过程中的多方参与。参与者的回答表明，ACP 专家计划的经验各不相同，并强调了与家属和居民（尤其是痴呆症患者）进行对话的许多相关方面。ACP 的益处（包括建立关系和提高对健康状况变化的准备程度）与敏感的谈话主题和安排 ACP 讨论的后勤困难相关的挑战是平衡的。ACP 专家讨论了其他人在 ACP 过程中扮演的多重角色：分析结果为在养老院环境中全面实施 APPROACHES 和其他 ACP 计划提供了启示。疗养院员工根据其环境调整项目的经验反映了 ACP 专家项目的实用性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Medical Directors Association 医学-老年医学

CiteScore

11.10

自引率

6.60%

发文量

472

审稿时长

44 days

期刊介绍： JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates. The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality