Share This Article:

Advance Directives in the Context of Uncertain Prognosis for Residents of Nursing Homes

Full-Text HTML Download Download as PDF (Size:309KB) PP. 321-329
DOI: 10.4236/ojn.2014.44037    2,540 Downloads   3,895 Views   Citations

ABSTRACT

This report documents the findings of a mixed-methods study focused on the advanced directives of 182 residents of three LTC facilities in southern Ontario, Canada. Although almost all had a completed advance directive within 3 months of death, most did not have a palliative designation or directive until a few days before they died. Each facility’s written Progress Notes revealed staff members usually sought additional confirmation of care preferences from residents’ substitute decision-makers within a few days of the death. It was thus common for advance directives to change from a more interventionist approach to the least interventionist approach near death. This change indicates that the meaning and significance of advance care planning and resulting advance directives must be considered in light of the processes and temporal factors involved in their completion and use within this distinct population. The relational nature of advance care planning and concern about ageism as a factor for withholding or withdrawing life support for LTC residents are considered as possible explanatory factors. These findings and their implications are described in relation to end-of-life care policies and practices in LTC facilities.

Cite this paper

Cable-Williams, B. , Donna M. Wilson, D. and Keating, N. (2014) Advance Directives in the Context of Uncertain Prognosis for Residents of Nursing Homes. Open Journal of Nursing, 4, 321-329. doi: 10.4236/ojn.2014.44037.

References

[1] Canadian Hospice Palliative Care Association (2012) Advance Care Planning in Canada: A National Framework and Implementation. http://www.chpca.net/projects-and-advocacy/projects/advance-care-planning.aspx
[2] Dionne-Odom, J.N. and Bakitas, M. (2012) Why Surrogates Don’t Make Decisions the Way We Think They Ought to. Journal of Hospice & Palliative Nursing, 14, 99-106.
http://dx.doi.org/10.1097/NJH.0b013e31823cc791
[3] Eskildsen, M.A. (2010) Medical Futility: Ethical, Legal, and Policy Issues. Annals of Long-Term Care, 18, 35-38.
[4] Bergman-Evans, B., Kuhnel, L., McNitt, D. and Myers, S. (2008) Uncovering Beliefs and Barriers: Staff Attitudes Related to Advance Directives. American Journal of Hospice and Palliative Medicine, 25, 347-353.
http://dx.doi.org/10.1177/1049909108320883
[5] Canadian Hospice Palliative Care Association (2012) Fact Sheet: Hospice Palliative Care in Canada.
http://www.chpca.net/media/319587/fact_sheet_hpc_in_canada_fall_2013_final.pdf
[6] Wilson, D.M., Houttekier, D., Kunju, S.A., Birch, S., Cohen, J., MacLeod, R. and Hewitt, J.A. (2013) A Population-Based Study on Advance Directive Completion and Completion Intention among Citizens of the Western Canadian Province of Alberta. Journal of Palliative Care, 29, 5-12.
[7] Ahearn, D.J., Jackson, T.B., McIlmoyle, J. and Weatherburn, A.J. (2010) Improving End-of-Life Care for Nursing Home Residents: An Analysis of Hospital Mortality and Readmission Rates. Postgraduate Medical Journal, 86, 131-135. http://dx.doi.org/10.1136/pgmj.2008.076430
[8] Jackson, J., Derderian, L., White, P., et al. (2012) Family Perspectives on End-of-Life Care: A Metasynthesis. Journal of Hospice and Palliative Nursing, 14, 303-311.
http://dx.doi.org/10.1097/NJH.0b013e31824ea249
[9] Johnson, M., Attree, M., Jones, I., Al Gamal, E. and Garbutt, D. (2013) Diagnosis, Prognosis and Awareness of Dying in Nursing Homes: Towards the Gold Standard? International Journal of Older People Nursing.
http://dx.doi.org/10.1111/opn.12024
[10] Menec, V. H., Nowicki, S., Blandford, A. and Veselyuk, D. (2009) Hospitalizations at the End of Life among Long-Term Care Residents. Journal of Gerontology A: Medical Sciences, 64A, 395-402.
[11] Daaleman, T.P., Williams, C.S., Preisser, J.S., Sloane, P.D., Biola, H. and Zimmerman, S. (2009) Advance Care Planning in Nursing Homes and Assisted Living Communities. Journal of the American Medical Directors Association, 10, 243-251. http://dx.doi.org/10.1016/j.jamda.2008.10.015
[12] Luxton, K. (2012) NPSTAT’s Long-Term Care Outreach Nurse Practitioners Provide End-of-Life Care at the Bedside. Central East Local Health Integration Network.
http://www.centraleastlhin.on.ca/newsroom_display.aspx?id=23348
[13] Shanley, C., Whitmore, E., Conforti, D., Masso, J., Jayasighe, S. and Griffiths, R. (2011) Decisions about Transferring Nursing Home Residents to Hospital: Highlighting the Roles of Advance Care Planning and Support from Local Hospital and Community Health Services. Journal of Clinical Nursing, 20, 2897-2906.
http://dx.doi.org/10.1111/j.1365-2702.2010.03635.x
[14] Shanley, C., Whitmore, E., Khoo, A., Cartwright, C., Walker, A. and Cumming, R.G. (2009) Understanding How Advance Care Planning is Approached in the Residential Aged Care Setting: A Continuum Model of Practice as an Explanatory Device. Australian Journal on Ageing, 28, 211-215.
[15] Givens, J.L., Kiely, D.K., Kristen, C. and Mitchell, S.L. (2009) Healthcare Proxies of Nursing Home Residents with Advanced Dementia: Decisions They Confront and Their Satisfaction with Decision-Making. Journal of the American Geriatrics Society, 57, 1149-1155. http://dx.doi.org/10.1111/j.1532-5415.2009.02304.x
[16] Cable-Williams, B.E. and Wilson, D.M. (2014) Awareness of Impending Death for Residents of Long-Term Care Facilities. International Journal of Older People Nursing, Early View.
http://dx.doi.org/10.1111/opn.12045
[17] (2007) Long-Term Care Homes Act of 2007, Ontario Regulation 79/10. § 42 & 52.
http://www.e-laws.gov.on.ca/html/source/regs/english/2010/elaws_src_regs_r10079_e.htm
[18] Boeije, H. (2002) A Purposeful Approach to the Constant Comparative Method in the Analysis of Qualitative Interviews. Quality & Quantity, 36, 391-409. http://dx.doi.org/10.1023/A:1020909529486
[19] Gillick, M. (2009) Decision Making near Life’s End: A Prescription for Change. Journal of Palliative Medicine, 12, 121-125. http://dx.doi.org/10.1089/jpm.2008.0240
[20] Cable-Williams, B.E. (2011) The Influence of Long-Term Care Culture on Awareness of Impending Death. Ph.D. Dissertation, University of Alberta, Edmonton.
[21] Hov, R., Hedelin, B. and Athlin, E. (2013) Nursing Care for Patients on the Edge of Life in Nursing Homes: Obstacles Are Overshadowing Opportunities. International Journal of Older People Nursing, 8, 50-60.
[22] Shield, R.R., Wetle, T., Teno, J., Miller, S.C. and Welch, L.C. (2010) Vigilant at the End of Life: Family Advocacy in the Nursing Home. Journal of Palliative Medicine, 13, 573-579.
[23] Lopez, R.P. (2009) Doing What’s Best: Decisions by Families of Acutely Ill Nursing Home Residents. Western Journal of Nursing Research, 31, 613-626.
[24] Badger, J.M. (2005) Factors that Enable or Complicate End-of-Life Transitions in Critical Care. American Journal of Critical Care, 14, 513-521.
[25] Forbes, S., Bern-Klug, M. and Gessert, C. (2000) End-of-Life Decision Making for Nursing Home Residents with Dementia. Journal of Nursing Scholarship, 32, 251-258.
http://dx.doi.org/10.1111/j.1547-5069.2000.00251.x
[26] Jacobs, L.G., Bonuck, K., Burton, W. and Mulvihill, M. (2002) Hospital Care at the End-of-Life: An Institutional Assessment. Journal of Pain and Symptom Management, 24, 291-298.
http://dx.doi.org/10.1016/S0885-3924(02)00494-3
[27] Kaufman, S.R. (1998) Intensive Care, Old Age, and the Problem of Death in America. The Gerontologist, 38, 715-725.
http://dx.doi.org/10.1093/geront/38.6.715
[28] Kaufman, S.R., Shim, J.R. and Russ, A.J. (2004) Revisiting the Biomedicalization of Aging: Clinical Trends and Ethical Challenges. The Gerontologist, 44, 731-738.
http://dx.doi.org/10.1093/geront/44.6.731
[29] Travis, S., Loving, G., McClanahan, L. and Bernard, M. (2001) Hospitalization Patterns and Palliation in the Last Year of Life among Residents in Long-Term Care. The Gerontologist, 41, 153-160.
http://dx.doi.org/10.1093/geront/41.2.153
[30] Bern-Klug, M. (2006) Calling the Question of “Possible Dying” among Nursing Home Residents: Triggers, Barriers, and Facilitators. Journal of Social Work in End-of-Life and Palliative Care, 2, 61-85.
http://dx.doi.org/10.1300/J457v02n03_06
[31] Murray, S.A., Kendall, M., Boyd, K. and Sheikh, A. (2005) Illness Trajectories and Palliative Care. British Journal of Medicine, 330, 1007-1011. http://dx.doi.org/10.1136/bmj.330.7498.1007
[32] Sampson, E.L., Jones, L., Thuné-Boyle, I.C.V., et al. (2010) Palliative Assessment and Advance Care Planning in Severe Dementia: An Exploratory Randomized Controlled Trial of a Complex Intervention. Palliative Medicine, 25, 197-209. http://dx.doi.org/10.1177/0269216310391691

  
comments powered by Disqus

Copyright © 2017 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.