Advance care planning practices in the nursing home setting : A secondary analysis

Journal article


Laging, Bridget L., Nay, Rhonda, Bauer, Michael, Laging, Rohan, Walker, Katie and Kenny, Amanda. (2021). Advance care planning practices in the nursing home setting : A secondary analysis. Gerontologist. 61(8), pp. 1307-1316. https://doi.org/10.1093/geront/gnab028
AuthorsLaging, Bridget L., Nay, Rhonda, Bauer, Michael, Laging, Rohan, Walker, Katie and Kenny, Amanda
Abstract

Background and Objectives
Advance care planning is intended to support residents’ preferences regarding health decisions, even when they can no longer participate. Little is known about the power discourses influencing how residents, family members, and health care workers engage in advance care planning and how advance care directives are used if a conflict arises. A large critical ethnographic study was conducted exploring decision making when a resident’s health deteriorates in the nursing home setting. Advance care planning practices were not the focus of the original study, but the richness of the data warranted further exploration. A new research question was developed to inform a secondary analysis: How does advance care planning influence the relationship between resident values and clinical expertise when determining a direction of care at the time of a resident deterioration?

Research Design and Methods
A secondary analysis of data from an ethnographic study involving 184 h of participatory observation, 40 semistructured interviews and advance care planning policies, and document review undertaken in two nursing homes in Melbourne, Australia.

Results
Advance care planning may result in inaccurate documentation of residents’ preferences and devalue clinical decision making and communication with residents and family members at the time of deterioration.

Discussion and Implications
Advance care planning may contribute toward a reductionist approach to decision making. There is an urgent need for the development of evidence-based policy and legislation to support residents, families, and health care workers to make appropriate decisions, including withholding invasive treatment when a resident deteriorates.

Keywordsaged care; decision making; hospitalization; shared decision making; withholding treatment
Year2021
JournalGerontologist
Journal citation61 (8), pp. 1307-1316
PublisherOxford University Press
ISSN0016-9013
Digital Object Identifier (DOI)https://doi.org/10.1093/geront/gnab028
PubMed ID33624074
Research or scholarlyResearch
Page range1307-1316
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online14 Feb 2021
Publication process dates
Deposited15 Dec 2021
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https://acuresearchbank.acu.edu.au/item/8x311/advance-care-planning-practices-in-the-nursing-home-setting-a-secondary-analysis

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