Beyond Visitation: Perceived Meaning of Family Involvement and Advance Directive Completion in Nursing Homes

To examine factors associated with advance directive (AD) completion among nursing home residents in Taiwan, focusing on family visitation patterns and the perceived meaning of family involvement.

A cross-sectional study.

Data from 134 family caregivers and their corresponding nursing home residents from seven nursing homes in northern Taiwan were analysed. Family caregiver data were collected using validated questionnaires, including the Family Meaning of Nursing Home Visits (FMNHV) scale. Multiple logistic regression was conducted, with candidate variables specified based on the study's conceptual framework and prior literature and refined using AIC-based forward and backward stepwise selection.

The AD completion rate was 34.3%. Completion was associated with residents' prior expression of end-of-life preferences (OR = 14.33, 95% CI = 4.39-46.80) and caregivers' awareness of ADs (OR = 4.20, 95% CI = 1.29-13.65). Compared with daily visits, weekly visits were associated with lower odds of completion (OR = 0.23, 95% CI = 0.07-0.81), as were visits lasting 61 min or longer compared with those lasting less than 30 min (OR = 0.16, 95% CI = 0.03-0.79). Higher scores on the FMNHV responsibility for care quality subscale were associated with greater odds of completion (OR = 1.24, 95% CI = 1.11-1.39).

Family involvement in AD completion extends beyond visitation patterns to include the perceived meaning of involvement. Both behavioural and interpretive dimensions should be considered when understanding AD completion in nursing homes.

Nurses should consider both visitation patterns and the perceived meaning of family involvement when facilitating discussions about AD completion with residents and their families.

This study identifies family involvement-related factors associated with AD completion and provides insights for nursing practice, staff training and advance care planning in long-term care settings.

We adhered to the STROBE guidelines.

No patient or public contribution.