Continuing a series of posts from members of the ACTION Consortium about their European study that aims to investigate how to support people with advanced cancer to have a conversation about preferences and wishes.
Joni Gilissen, MSc, PhD student at the Interuniversity End-of-Life Care Research Group of Ghent University and Vrije Universiteit Brussel, Belgium, explains the background to her systematic review about preconditions for implementing advance care planning in nursing homes, that has been published in the International Journal of Nursing Studies.
Advance care planning (ACP) is a complex intervention, consisting of multiple interacting components. It includes not only facilitated reflection and dialogue between patients, family and care providers and/or the completion of advance directives, but also requires fundamental changes in the provision and culture of health care within a facility.
Background and aim of the study
Implementing ACP into routine care can only work when it is provided as a pragmatic ‘whole-system’ approach.
This argument has been made for quite some time now. Our systematic review is the first to provide a summary of important preconditions that should especially be targeted by an ACP programme in nursing homes. Determining such preconditions in an early stage can enable you, as a practitioner or as a researcher, to think first about what is actually needed (e.g. contextual conditions, human or financial resources), before implementing a range of intervention components such as a training, a structured interview guide or a standardized document for care preferences.
We identified 17 preconditions that were grouped into five overall domains:
- Sufficient knowledge and skills, e.g. knowledge about ACP, the illness or condition, treatment options, ACP-related legal issues.
- Willingness and ability to participate in ACP, e.g. supportive culture for ACP, open attitude towards talking about death and dying, being confident and comfortable engaging in ACP.
- Good relationships, e.g. between staff and residents, staff and family, family dynamics.
- Availability of an administrative system for documenting wishes and monitoring care, e.g. clear and accessible written record, monitoring of consistency between care and wishes, feedback to healthcare professionals involved.
- Supportive contextual factors, e.g. sufficient time and resources, part of standard care, community approach included.
Can these findings be transferred to the hospital setting?
Although this review focused on the nursing home setting, the majority of the identified preconditions could also be applicable to the hospital setting. Mariëtte Verkissen, MSc, working as a PhD student at the End-of-Life Care Research Group and member of the ACTION consortium, thinks that the results could be very interesting in the light of the ACTION trial.
“Within ACTION we study the effects of an ACP programme, Respecting Choices, on quality of life of patients with advanced cancer in six European countries with different cultural contexts and healthcare systems. The findings of this review stress the importance of collecting background data for each participating hospital in ACTION (e.g. number of palliative care services, description of common practices regarding end-of-life decision-making, attitudes towards end-of-life care discussions of professional caregivers), and for each country (e.g. policies related to the provision of palliative care and ACP), because these conditions could influence the implementation of the ACP programme.”
Read the full article
This post relates to the article, ‘Preconditions for successful advance care planning in nursing homes: A systematic review’ by Joni Gilissen, Lara Pivodic, Tinne Smets, Chris Gastmans, Robert Vander Stichele, Luc Deliens, and Lieve Van den Block, International Journal of Nursing Studies 2017 Vol. 66, pages 47-59.
Links and resources
- ACTION (Advance Care Planning – An Innovative Palliative Care Intervention to Improve Quality of Life in Oncology) – Follow us on Twitter @ACPinScience
- Read more posts from the ACTION Consortium on the EAPC Blog.
- End-of-Life Care Research Group – Follow us on Twitter @EoLC research
- Communication about the end of life in nursing homes: a cluster randomised controlled trial. [Accessed 13 February 2017].
Join us in Madrid for the 15th World Congress of the European Association for Palliative Care – #EAPC2017
Meet colleagues from the ACTION Project at the congress:
Oral presentation, Friday 19 May at 11.15-12.45 in room N101/N102. Urska Lunder presents: ‘Measuring Fidelity of Implementation of Advance Care Planning Model in ACTION Project’ in the End of Life Ethics session.
Posters: Poster Set One on Thursday 18 May
- ‘Experiences and Opinions of Teachers about Education in Advance Care Planning in ACTION Project’ – Urska Lunder, P01-203
- ‘Health Care Professionals’ Experiences with Conducting Advance Care Planning Conversations in Oncology: An International Focus Group Study’ – Marieke Zwakman, no: P01-168.
- ‘Development of a Data Extraction Form for the Review of Hospital Medical Records in Six European Countries. The EU FP-7 Funded International ACTION Study on Advance Care Planning’ – Mariëtte Verkissen, no: P01-439.
To view the full congress programme and to register, please visit the congress website.