Table of Contents
International Journal of Palliative Care
Volume 2014, Article ID 358457, 8 pages
http://dx.doi.org/10.1155/2014/358457
Research Article

Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

1Centre for Education and Research on Aging and Health, Lakehead University, 955 Oliver Road, Thunder Bay, ON, Canada P7B 5E1
2School of Social Work and Northern Ontario School of Medicine, Lakehead University, 955 Oliver Road, Thunder Bay, ON, Canada P7B 5E1

Received 30 November 2013; Revised 10 March 2014; Accepted 16 March 2014; Published 14 April 2014

Academic Editor: Phillip J. Newton

Copyright © 2014 Kimberly Ramsbottom and Mary Lou Kelley. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Long term care (LTC) homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP) important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descriptive study conducted 34 individual semistructured interviews in two LTC homes, located in Canada. The participants were 31 family members and three staff, consisting of a front line care worker, a registered nurse, and a nurse practitioner. All participants perceived ACP conversations as valuable to provide “resident-centred care”; however, none of the participants had a good understanding of ACP, limiting its effectiveness. Strategies generated through the research to improve ACP were as follows: educating families and staff on ACP and end-of-life care options; better preparing staff for ACP conversations; providing staff skills training and guidelines; and LTC staff initiating systematic, proactive conversations using careful timing. These strategies can guide quality improvement of palliative care and development of ACP tools and resources specific to the LTC home sector.