Tim Luckett , Dimity Pond , Geoffrey Mitchell , Lynnette Chenoweth , Ingrid Amgarth-Duff , Domenica Disalvo , Jane Louise Phillips , Elizabeth Beattie , Patricia Mary Davidson , Georgina Luscombe , Stephen Goodall , Meera Agar
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引用次数: 0
Abstract
Background
Advanced dementia is a life-limiting illness that requires a palliative approach to care. Decline in eating/drinking represents a milestone in progression that warrants decision-making and planning of care. In long-term care (LTC), this is best conducted via family case conferences.
Aim
To explore decision-making and planning regarding eating/drinking-related care in case conferences for persons with advanced dementia in LTC to inform future practice.
Methods
A qualitative approach was taken, using observation of audio-recorded case conferences. Case conferences were conducted in 6 LTC facilities within the intervention arm of a cluster randomized controlled trial. Participants were LTC personnel, doctors, and families of persons with advanced dementia. Content was analysed for eating/drinking-related goals of care and the degree to which decision-making was shared.
Findings
Thirty-two case conferences considered eating/drinking-related care. The goals included nutrition, hydration, weight gain and maintenance, food enjoyment, social interaction, and independence. Key considerations included secondary health issues impacting comfort, and tensions between food enjoyment versus nutrition and risk of aspiration. While families contributed essential information about eating/drinking history, sometimes decision-making was dominated by professionals and overlooked overall goals of care.
Discussion
Shared decision-making regarding eating/drinking-related care for persons with advanced dementia in LTC should start with consensus on overall goals of care and include contributions to quality of life as well as risks. Family involvement should be supported beyond information-giving.
Conclusion
Future studies are needed to identify the most sensitive and understandable ways for families of discussing eating/drinking-related decline in dementia.
期刊介绍：
Collegian: The Australian Journal of Nursing Practice, Scholarship and Research is the official journal of Australian College of Nursing (ACN).
The journal aims to reflect the broad interests of nurses and the nursing profession, and to challenge nurses on emerging areas of interest. It publishes research articles and scholarly discussion of nursing practice, policy and professional issues.
Papers published in the journal are peer reviewed by a double blind process using reviewers who meet high standards of academic and clinical expertise. Invited papers that contribute to nursing knowledge and debate are published at the discretion of the Editor.
The journal, online only from 2016, is available to members of ACN and also by separate subscription.
ACN believes that each and every nurse in Australia should have the opportunity to grow their career through quality education, and further our profession through representation. ACN is the voice of influence, providing the nursing expertise and experience required when government and key stakeholders are deciding the future of health.
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