Let me talk--an advance care planning programme for frail nursing home residents

Aims and objectives: This study attempted to test the plausibility of engaging frail nursing home residents in advance care planning (ACP).

Background: Advance care planning fosters communication among individuals, family and health professionals regarding end-of-life care. Yet, such practice seldom takes place in a timely fashion because of its sensitive nature; thus, the concerns of these residents are often left unattended.

Design: This was a one-year quasi-experimental study to test the feasibility of the Let Me Talk ACP programme, with its design being inspired by literature and our earlier work, among frail nursing home residents.

Method: Three assessments were conducted at six-month intervals to monitor the programme effects. The storytelling approach, which allowed participants to thread together their past, present and future, was the key feature of the programme.

Results: Findings showed that the treatment preference stability was significantly higher in the intervention group (κ = 0.53, p ≤ 0.001). Significantly more participants in this group also communicated their treatment preferences to their family or caregivers (p = 0.012), with an odds ratio of 4.52. The programme also had a positive effect on mitigating participants' existential distress.

Conclusions: The programme was found effective in clarifying participants' treatment preferences and encouraging them to communicate their preferences to significant others. However, it was also found that involving participants' family in open discussion remained difficult. Extensive promotion in the community is therefore necessary.

Relevance to clinical practice: It is recommended that such ACP programmes should be integrated into nursing home care practice, as they can be initiated in a relaxed atmosphere and maintained as an ongoing process. The trusting relationship between the nurse in the homes and the residents enables in-depth discussion. The nurse is also well placed to play the facilitator role in guiding the process, providing information and mediating the family discussion.