Evaluation of the implementation of a multi-component advance care planning programme in nursing homes

Advance care planning (ACP) increases the likelihood that nursing home (NH) residents will receive end-of-life care that is consistent with their preferences. However, their preferences are often unknown. This paper aims to identify the key enablers and constraints that influenced the implementation of a new multicomponent ACP programme. A qualitative study guided by the Normalisation Process Theory was conducted. Six ACP leaders and eighteen implementers participated in interviews and focus group discussions respectively. Data were analysed using reflexive thematic analysis and revealed five themes: (1) making sense of ACP in a NH context, (2) upskilling with new processes, (3) lack of collective action to adapt and integrate ACP, (4) appraisal of structural and process challenges, and (5) experience of cognitive dissonance. While the programme supported the building of individual and collective competency for ACP facilitation, prevailing sectoral and organisational context challenged NHs' ability to integrate ACP and to reap its expected benefits.