Stakeholder Perspectives on Integrating ADEPT Into End-Of-Life Care for Nursing Home Residents With Dementia: A...

Nursing homes care for a significant proportion of individuals with advanced dementia, yet timely hospice referrals remain a challenge. The Advanced Dementia Prognostic Tool (ADEPT) is a mortality risk score instrument that holds promise for improving care planning by providing a standardised, accessible method for identifying residents at risk of death within 6 months.

To describe current nursing home processes for identifying residents with dementia for hospice referral and gather stakeholder input on integrating ADEPT into routine assessment practices.

A qualitative descriptive design guided by the Consolidated Framework for Implementation Research (CFIR) was employed. Data were gathered through online surveys and individual interviews (n = 5) as well as a focus group (n = 4) with interdisciplinary staff from six Florida nursing homes. Analysis involved deductive coding using a CFIR-based codebook and thematic synthesis.

The Standards for Reporting Qualitative Research (SRQR) checklist was followed.

Current processes for identifying hospice-eligible residents rely on regular assessments and interdisciplinary collaboration but reveal significant gaps, including delays in referrals and inconsistent practices. Participants viewed ADEPT as a promising tool to complement goals-of-care conversations and enhance care planning, rather than exclusively triggering hospice initiation. Implementation barriers included the need for electronic system integration, regulatory compliance and staff education, while facilitators encompassed strong leadership support, interdisciplinary coordination and alignment with existing workflows.

ADEPT has the potential to improve hospice referral processes in nursing homes by providing a structured, accessible framework to support care planning and interdisciplinary discussions. Addressing barriers through targeted training, leadership engagement and pilot testing is essential to optimise its implementation and impact.

ADEPT could support end-of-life care in nursing homes by fostering timely, goal-directed care planning for residents with dementia, ultimately enhancing both care quality and staff decision-making processes.