Rights statement: The final, definitive version of this article has been published in the Journal, Palliative Medicine, 32 (3), 2018, © SAGE Publications Ltd, 2018 by SAGE Publications Ltd at the Palliative Medicine page: http://journals.sagepub.com/home/pmj on SAGE Journals Online: http://journals.sagepub.com/
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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
}
TY - JOUR
T1 - Effectiveness of advance care planning with family carers in dementia nursing homes
T2 - a paired cluster randomized controlled trial
AU - Brazil, Kevin
AU - Carter, Gillian
AU - Cardwell, Chris R.
AU - Clarke, M.
AU - Hudson, Peter
AU - Froggatt, Katherine Alison
AU - McLaughlin, Dorry
AU - Passmore, Peter
AU - Kernohan, George
N1 - The final, definitive version of this article has been published in the Journal, Palliative Medicine, 32 (3), 2018, © SAGE Publications Ltd, 2018 by SAGE Publications Ltd at the Palliative Medicine page: http://journals.sagepub.com/home/pmj on SAGE Journals Online: http://journals.sagepub.com/
PY - 2018/3/1
Y1 - 2018/3/1
N2 - BackgroundIn dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor.AimTo evaluate the effectiveness of advance care planning with family carers in dementia care homes.DesignPaired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff.Setting/participantsA total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions.ResultsThe primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (−10.5, 95% confidence interval: −16.4 to −4.7; p < 0.001).ConclusionAdvance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.
AB - BackgroundIn dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor.AimTo evaluate the effectiveness of advance care planning with family carers in dementia care homes.DesignPaired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff.Setting/participantsA total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions.ResultsThe primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (−10.5, 95% confidence interval: −16.4 to −4.7; p < 0.001).ConclusionAdvance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.
KW - Advance care planning
KW - randomized controlled trial
KW - dementia
KW - family caregivers
U2 - 10.1177/0269216317722413
DO - 10.1177/0269216317722413
M3 - Journal article
VL - 32
SP - 603
EP - 612
JO - Palliative Medicine
JF - Palliative Medicine
SN - 0269-2163
IS - 3
ER -