School of Medicine, Indiana University, Indianapolis, IN, USA; IU Center for Aging Research, Regenstrief Institute, Indianapolis, IN, USA.
University of Colorado School of Medicine, Aurora, CO, USA.
J Am Med Dir Assoc. 2024 Nov;25(11):105265. doi: 10.1016/j.jamda.2024.105265. Epub 2024 Sep 14.
Advance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences - a Role offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP.
Qualitative interviews regarding ACP specialists' experiences and perceived intervention impact.
Staff of intervention-assigned nursing home facilities who completed a minimum of 10 ACP conversations with residents during APPROACHES program implementation.
Fourteen staff were interviewed. Interviews were transcribed and coded by the research team.
There were 21 codes identified that were then distilled into the following 5 themes: (1) experiences with the ACP specialist program, (2) engaging in ACP conversations, (3) considerations related to dementia, (4) benefits and challenges of ACP, and (5) involvement of multiple people in the ACP process. Participant responses suggested variability in experiences with the ACP specialist program and highlighted many aspects relevant to engaging in conversations with families and residents, particularly those living with dementia. Benefits of ACP, including relationship building and increased preparedness for changes in health status, were balanced with challenges related to sensitive conversation topics and logistical difficulties in scheduling ACP discussions. ACP specialists discussed the multiple roles that others played in the ACP process.
Findings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.
在养老院环境中，预先医疗指示（ACP）被认为是最佳实践；然而，养老院工作人员的培训和结构化 ACP 计划的实施缺乏一致性。对养老院 ACP 专家进行了一项定性研究，以了解参与“使患者偏好一致-为阿尔茨海默病患者、护理人员和医疗保健提供者提供教育和支持的角色”（APPROACHES）的员工的经验，这是一项嵌入式实用临床试验，旨在改善 ACP。
关于 ACP 专家经验和感知干预影响的定性访谈。
在 APPROACHES 计划实施期间，与居民完成至少 10 次 ACP 对话的干预分配养老院设施的工作人员。
对 14 名员工进行了访谈。研究小组对访谈进行了转录和编码。
确定了 21 个代码，然后将其提炼为以下 5 个主题：（1）ACP 专家计划的经验，（2）进行 ACP 对话，（3）与痴呆相关的考虑，（4）ACP 的好处和挑战，以及（5）多人参与 ACP 过程。参与者的回答表明，他们在 ACP 专家计划方面的经验存在差异，并强调了与家庭和居民进行对话的许多方面，特别是与患有痴呆症的居民。ACP 的好处包括建立关系和为健康状况的变化做好更充分的准备，但也存在与敏感话题对话和安排 ACP 讨论的后勤困难相关的挑战。ACP 专家讨论了其他人在 ACP 过程中扮演的多个角色。
这项分析的结果提供了有关为养老院环境中全面实施 APPROACHES 和其他 ACP 计划进行调整的见解。养老院工作人员根据环境调整计划的经验反映了 ACP 专家计划的实用性质。
