Four timing patterns of initiation of advance care planning discussions as practiced by home visiting nurses: A qualitative study

Abstract

Background

The purpose of this study was to explore the actual timing of the initiation of advance care planning (ACP) discussions by experienced visiting nurses for older homebound patients.

Methods

Semi-structured interviews were conducted with 12 home visit nurses, followed by a qualitative, inductive analysis.

Results

Four ACP initiation timing patterns were extracted.

Conclusions

Home visit nurses used the following timing patterns differently depending on each patient's situation: “Starting when visiting nurses get to know the patients,” “Waiting for a change in the patient's medical condition,” “Waiting to begin ACP discussions until the patient and nurse are emotionally ready,” and “Starting ACP discussions in a proactive, but non-shocking manner.”