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Abstract
Objective
To explore family members’ experiences of advance care planning in nursing homes.
Design
Individual interviews. Thematic analysis.
Setting
Four nursing homes in Sweden.
Subjects
Eighteen family members of deceased nursing home patients.
Main outcome measures
Family members’ experiences of advance care planning in nursing homes.
Results
Family members’ experiences of advance care planning in a nursing home context involved five themes: Elephant in the room, comprising end-of-life issues being difficult to talk about; Also silent understanding, e.g. patient’s preferences explicitly communicated, but also implicitly conveyed. In some cases family members had a sense of the patient’s wishes although preferences had not been communicated openly; Significance of small details, e.g. family members perceive everyday details as symbols of staff commitment; Invisible physician, supporting nurse, e.g. nurse being a gatekeeper, providing a first line assessment in the physician’s absence; and Feeling of guilt, e.g. family members wish to participate in decisions regarding direction of care and treatment limits, and need guidance in the decisions.
Conclusion
Our study stresses the significance of staff involving the patient and family members in the advance care planning process in nursing homes, thereby adapting the care in line with patient’s wishes, and for the patient to share these preferences with family members. Education in communication related to the subject may be important to shape advance care planning.
Knowledge on advance care planning (ACP) in a nursing home (NH) context from the perspective of family members is limited.
Role of the nurse in ACP is seen as central, whereas physician involvement is often perceived to be lacking.
Significance of small details, perceive to symbolize staff competence and respect for patient autonomy.
To limit family members’ feeling of guilt, communicating end-of-life issues is important in order to align ACP with patient preferences.
Key points
Acknowledgements
The authors thank the family members participating in this study and the nurses at the nursing homes for their help with recruitment of the participants. The authors also thank Anchor English for linguistic revisions.
Ethics approval and consent participate
The study was approved by the Regional Ethical Review Board in Linköping (Dnr 2018/173-31).
Disclosure statement
The authors declare that they have no competing interests.