Table 2 Clinical intervention studies
From: A review of the implementation and research strategies of advance care planning in nursing homes
| Author | Population | Intervention-tool/education/aim of the study? |
Comparison Methods Outcome measures | Outcome/themes/results | Promoters | Barriers |
|---|---|---|---|---|---|---|
|
Livingston G, 2013 London, UK |
Patients w/dementia who died before (N = 98), during (N = 56) or after (N = 42) the intervention mean MMSE = 5 |
Tool - GSFCH - Chart for choices Education - Learning course - 10-session manualized, interactive staff-training program Practical training - Facilitators |
- Non-randomized intervention study, 2-year follow-up - Mixed methods - Interviews w/relatives - Review of med. records - QoL-AD, GHQ, DNR, ACP, days in hospital |
- Better palliative approach - Fewer deaths in hospitals (from 76 to 47 %) - Better documentation of DNR orders (from 14 to 73 %) & ACP discussions (from 39 to 65 %) - No difference for days spent in hospital - More satisfied relatives - Staff more comfortable with addressing ACP-issues |
- Staff training to increase awareness & knowledge & reduce fear - Motivated NH management - Trained in Gold Standard Framework - Low staff turn over |
- Different dementia policy actions at the same time-change findings - Different cultures? Laws (e.g., Jewish tradition NH) - Adaption addressing different cultures in NHs necessary |
|
Silvester W, 2013 Victoria area, Australia |
19 Residential Aged Care Facilities (RACF) 203 Patients’ records Cognitive function not specified |
Tool Making Health Choices |
- Non-randomized controlled trial - Quantitative methods - Analysis of patient records, documented ACP pre/post-intervention timeframe not specified |
- Better documentation of EOLC preferences & ACP discussions - 49 % MEPOA - >90 % value/beliefs - 78 % health perspectives |
- Standards guiding ACP content & documentation - Ex. of values/belief statements in care plans - 17 principles of ACP (e.g., policies, education, information, routines, best interest, Inevitability of death, options, GP, EOLC, documentation confidentiality) | - Inconsistencies in naming & layout of ACP documentation |
|
Hockley J, 2010, Scotland, UK |
7 NHs 133 patients assessed as in need of ACP, who died during intervention, 95 controls (patients who died a year prior to intervention) 66 % were diagnosed with dementia |
Tool - GSFCH - LCP Education - Learning course - Practical training - Workshops - Train the trainer - Facilitators - Support from researchers |
- Intervention study, 18-months. follow-up - Mixed methods - Chart review - Survey of health care personnel - Qualitative interview of bereaved relatives (results not reported) |
- Better palliative approach - Fewer hospital deaths - Staff comfortable with addressing ACP-issues |
- Good consistent leadership - Regular visits from the same GP - More comprehensive palliative care approach | - Problems with staff turnover, retention & recruitment |
|
Chan HY, 2010 Hong Kong |
Competent NH patients: - 59 intervention - 62 control |
Tool - Let me Talk Education - Semi-structured interview guide |
- Non-randomized controlled feasibility study, 12-months. follow-up - Quantitative methods - Questionnaire based survey |
- Only 3 families included - Stability of treatment preference - More preference stated - Relieved existential anxiety/distress |
- Time consuming - Unclear effect in incompetent people/with dementia & older people | |
|
Morrison RS, 2005 NY City, USA, |
- 4 Social workers (2 control/intervention) - 139 LTC residents: 96 control 43 intervention |
Tool - Structured ACP discussion with patient & relatives at admission, 1 year & changes in clinical status Education - Counselling of NH social workers - Education/training: Terms/definitions, role-play, supervision - Practical training - Workshops |
- Controlled clinical trial, 6-months. follow-up - Mixed methods - Minimum data set at admission - Interview of Social workers - Review of medical records |
- Better documentation of EOLC preferences & ACP discussions - Better concordance between patient wishes & provided treatment |
- High focus on decision capacity & proxy relative - Simple intervention of forms, team meetings, feedback to clinicians by social workers improves likelihood of residents preferences being elicited |
- Few social workers - Lack of documentation - Short follow up - Legislation restricting surrogate decision making on behalf persons with reduced decision capacity |