Perspectives of older people living in long-term care facilities and of their family members
toward advance care planning discussions: A systematic review and thematic synthesis
CLINICAL INTERVENTIONS IN AGING | Online – 3 March 2017 – This review suggests that barriers to advance care planning (ACP) for older people living in long-term care (LTC) facilities are more related to health care professionals’ willingness to initiate ACP conversations than to patients’ and family members’ willingness to be involved in such a process. In fact, the results of this review proposes that residents and their families rely on health care professionals’ expertise and judgment and desire their involvement in end-of-life (EoL) care decision-making. This finding is consistent with previous studies and highlights the urgent need to enhance health care professionals’ knowledge, skills and comfort in ACP conversations. Health care professionals who know an elder well were considered the ideal group of people to initiate ACP, and most elders and their families expected health care providers to initiate and anticipate their needs concerning EoL issues. The findings indicate that elders and their families desired a personalized approach by health care professionals within a relationship based on trust, respect and sensitivity. Regarding the “right time” to perform ACP, further studies are needed in order to develop appropriate guidance on approaching both residents and their family members. This review shows that, at least for the current generation of older people living in LTC settings, planning for non-medical issues is very important, suggesting the need to rethink ACP for this population and also to incorporate non-medical preferences.