Advance Care Planning Practices in the Nursing Home Setting: A Secondary Analysis

Area of Science:

• Gerontology
• Healthcare Policy
• Medical Ethics

Background:

• Advance care planning (ACP) aims to uphold resident health preferences when they cannot participate.
• Limited understanding exists regarding power dynamics in ACP and the use of advance care directives during conflicts.
• A critical ethnographic study explored decision-making during resident deterioration in nursing homes.

Purpose of the Study:

• To investigate how advance care planning influences the interplay between resident values and clinical expertise during resident deterioration.
• To analyze the impact of ACP on communication and decision-making processes in aged care settings.

Main Methods:

• Secondary analysis of a critical ethnographic study.
• Data collection involved 184 hours of participatory observation and 40 semistructured interviews.
• Included review of advance care planning policies and documents from two Melbourne nursing homes.

Main Results:

• Advance care planning can lead to inaccurate documentation of resident preferences.
• ACP may devalue clinical decision-making and communication with residents and families during health crises.
• The process can foster a reductionist approach to complex care decisions.

Conclusions:

• There is an urgent need for evidence-based policies and legislation to guide ACP.
• Policies should support residents, families, and healthcare workers in making appropriate end-of-life decisions.
• This includes decisions on withholding invasive treatments when a resident's condition deteriorates.