Challenges in implementing an advance care planning programme in long-term care.

Area of Science:

• Gerontology
• Palliative Care
• Healthcare Management

Background:

• Cognitive impairment and frailty are prevalent in long-term care, hindering advance care planning.
• Implementing advance care planning programs in long-term care settings presents unique challenges.
• The 'Let Me Decide' program aimed to address these challenges in long-term care.

Purpose of the Study:

• To identify challenges in implementing the 'Let Me Decide' advance care planning program.
• To assess the feasibility and acceptability of structured advance care planning in long-term care.
• To explore strategies for overcoming barriers to advance care planning in this population.

Main Methods:

• A two-phase feasibility study involving staff education and structured advance care planning.
• Implementation in long-term care residents across nursing homes and a community hospital.
• Ethical approval obtained from the local research ethics committee.

Main Results:

• Over 50% of residents completed some form of end-of-life care plan post-implementation.
• For residents who died, 76% had an end-of-life care plan completed by the medical team after discussions.
• A significant logistical challenge in staff training led to the development of an e-learning program.

Conclusions:

• Advance care planning is feasible and acceptable for long-term care residents with variable capacity.
• The program facilitated end-of-life care planning through resident and family discussions.
• Nursing staff demonstrated willingness to adopt the program due to improved communication and peace of mind.