Mikaelsson Åsa, Eriksson Lars E, Stenfors Terese, Goliath Ida
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
School of Health and Psychological Sciences, City, University of London, London, UK.
BMC Geriatr. 2025 Apr 25;25(1):279. doi: 10.1186/s12877-025-05916-7.
Due to population aging, residential care homes are increasingly providing end-of-life care for residents with multiple chronic illnesses and cognitive decline. Proactive end-of-life communication, a component of Advance Care Planning, has been suggested as a means of providing high-quality care aligned with residents' preferences and supporting involved family members. Despite growing knowledge about the benefits of early communication concerning end-of-life care preferences, such conversations are still rare in the context of residential care homes, and little is known about how they are perceived by residents and family members. The aim of this study is to explore the outcomes experienced by residents and family members who have participated in proactive end-of-life conversations in residential care homes.
This qualitative study is embedded within a participatory action research project implementing proactive end-of-life conversations in five Swedish residential care homes, using a conversation tool. In this study we performed 18 interviews with eleven residents and eight family members after they had participated in staff initiated proactive end-of-life conversations. Data were analyzed using interpretive description.
Residents and family members experienced several outcomes of proactive end-of-life conversations presented in three closely interconnected themes: (1) Enabling open communication, (2) Creating space for knowledge exchange, and (3) Contributing to feelings of confidence and relationship building.
Proactive end-of-life conversations generated several beneficial outcomes for residents and family members, including those with cognitive decline. The study demonstrated that the conversations may strengthen person-centered care and family support in this context. Based on these findings, proactive end-of-life conversations have the potential for use by residential care home staff.
由于人口老龄化，养老院越来越多地为患有多种慢性疾病和认知能力下降的居民提供临终关怀。积极的临终沟通作为预立医疗照护计划的一部分，被认为是一种提供符合居民偏好的高质量护理并支持相关家庭成员的方式。尽管人们越来越了解就临终关怀偏好进行早期沟通的益处，但在养老院环境中，此类对话仍然很少见，而且对于居民和家庭成员如何看待这些对话知之甚少。本研究的目的是探讨在养老院参与积极临终对话的居民和家庭成员所经历的结果。
这项定性研究嵌入了一个参与式行动研究项目，该项目在瑞典的五家养老院使用一种对话工具开展积极的临终对话。在本研究中，我们在11名居民和8名家庭成员参与了工作人员发起的积极临终对话后，对他们进行了18次访谈。使用解释性描述对数据进行了分析。
居民和家庭成员经历了积极临终对话的几个结果，这些结果呈现为三个紧密相连的主题：（1）促进开放沟通，（2）为知识交流创造空间，（3）有助于增强信心和建立关系。
积极的临终对话为居民和家庭成员，包括认知能力下降者，带来了一些有益的结果。该研究表明，在这种情况下，这些对话可能会加强以人为主的护理和家庭支持。基于这些发现，积极的临终对话有被养老院工作人员采用的潜力。
