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Discussing advance care planning: insights from older people living in nursing homes and from family members

Published online by Cambridge University Press:  09 October 2017

Francesca Ingravallo ,
Veronica Mignani ,
Elena Mariani ,
Giovanni Ottoboni ,
Marie Christine Melon  and
Rabih Chattat
Francesca Ingravallo*
Affiliation:
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
Veronica Mignani
Affiliation:
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
Elena Mariani
Affiliation:
Department of Psychology (PSI), University of Bologna, Viale Carlo Berti Pichat 5, 4012 Bologna, Italy.
Giovanni Ottoboni
Affiliation:
Department of Psychology (PSI), University of Bologna, Viale Carlo Berti Pichat 5, 4012 Bologna, Italy.
Marie Christine Melon
Affiliation:
CADIAI, Via Boldrini 8, 40121 Bologna, Italy
Rabih Chattat
Affiliation:
Department of Psychology (PSI), University of Bologna, Viale Carlo Berti Pichat 5, 4012 Bologna, Italy.
*
Correspondence should be addressed to: Francesca Ingravallo, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Irnerio 49, 40126 Bologna, Italy. Phone: +39-0512088366; Fax +39-0512088358. Email: francesca.ingravallo@unibo.it.
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Abstract

Background:

Evidence concerning when and in which manner older people living in nursing homes (NHs) would prefer to discuss advance care planning (ACP) is still scarce. This study explored the attitudes of NH residents and family members toward ACP and their opinions as to the right time to broach the subject, the manner in which it should be approached, and the content of ACP.

Methods:

This was a qualitative study using face-to-face interviews with 30 residents (age range 66–94), and 10 family members from 4 Italian NHs. The interviews were analyzed using content analysis.

Results:

Three main themes were identified: (1) life in the NH, including thoughts about life in a nursing home, residents’ concerns, wishes and fears, and communication barriers; (2) future plans and attitudes toward ACP, including attitudes toward planning for the future and plans already made, and attitudes toward and barriers against ACP; (3) contents and manner of ACP, including contents of ACP discussions, the right moment to introduce ACP, with whom it is better to discuss ACP, and attitudes toward advance directives.

Conclusions:

ACP was a welcome intervention for the majority of participants, but an individualized assessment of the person's readiness to be involved in ACP is needed. For people with dementia, it is essential to identify the right time to introduce ACP before NH admission. Participants in our study suggested that ACP should include palliative care and practical issues, and that in the NH setting all staff and family members may have a valuable role in ACP.

Keywords

advance care directivesdecision-makingresidential facilitiesfrail elderlycaregiversdementiapalliative care
Type
Research Article
Information
International Psychogeriatrics , Volume 30 , Issue 4: Issue Theme: Delirium , April 2018 , pp. 569 - 579
Copyright
Copyright © International Psychogeriatric Association 2017 

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