Preconditions for successful advance care planning in nursing homes: A systematic review

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• 作者：Joni Gilissen^a ; ^{joni.gilissen@vub.ac.be} ; ^{jonigilissen@gmail.com} ; Lara Pivodic^a ; ^{lara.pivodic@vub.ac.be} ; Tinne Smets^a ; Chris Gastmans^b ; Robert Vander Stichele^c ; Luc Deliens^a ; ^d ; Lieve Van den Block^a ; ^e
• 关键词：Advance care planning ; Elderly care ; Long-Term care ; Nursing home ; Systematic review ; Theory of change
• 刊名：International Journal of Nursing Studies
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：66
• 期：Complete
• 页码：47-59
• 全文大小：991 K
• 卷排序：66

文摘

There is growing evidence of the potential effectiveness of advance care planning. Yet important knowledge gaps remain regarding the preconditions for successful implementation of advance care planning in the nursing home setting. We aim to identify the preconditions related to successful advance care planning in the nursing home setting. By specifying those, we would be able to make well-founded choices for the future design and planning of advance care planning intervention programs.DesignA systematic review.Data sourcesPubMed, PsycINFO, EMBASE and CINAHL.Review methodsTwo authors independently screened publications. One author assessed methodological quality and extracted textual data, which was double-checked for a random sample. We extracted textual data and used thematic synthesis to identify “preconditions”, defined as requirements, conditions and elements necessary to achieve the desired outcome of advance care planning, i.e. attaining concordance between residents' preferences and actual care or treatment received at the end of life.Main findingsBased on 38 publications, we identified 17 preconditions at five different levels: resident, family, health-care professional, facility and community. Most preconditions were situated on multiple levels but the majority addressed professionals and the nursing home itself. We summarized preconditions in five domains: to have sufficient knowledge and skills, to be willing and able to participate in advance care planning, to have good relationships, to have an administrative system in place, and contextual factors supporting advance care planning within the nursing home.ConclusionThere are multiple preconditions related to successfully implementing advance care planning in the complex nursing home setting that operate at micro, meso and macro level. Future interventions need to address these multiple domains and levels in a whole-system approach in order to be better implementable and more sustainable, while simultaneously target the important role of the health-care professional and the facility itself.