Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial

Kevin Brazil, Gillian Carter, Chris Cardwell, Mike Clarke, Peter Hudson, Katherine Froggatt, Dorry McLaughlin, Peter Passmore, W.George Kernohan

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

BACKGROUND:In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor.AIM:To evaluate the effectiveness of advance care planning with family carers in dementia care homes.DESIGN:Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff.SETTING/PARTICIPANTS:A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions.RESULTS:The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (-10.5, 95% confidence interval: -16.4 to -4.7; p <0.001).CONCLUSION:Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.
LanguageEnglish
Pages603-612
JournalPalliative Medicine
Volume32
Issue number3
Early online date8 Aug 2017
DOIs
Publication statusPublished - 1 Mar 2018

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Advance Care Planning
Nursing Homes
Caregivers
Dementia
Randomized Controlled Trials
Decision Making
Uncertainty
Family Nursing
Education
Northern Ireland
Quality of Health Care
Nursing Staff
Home Care Services
Administrative Personnel
Documentation
General Practitioners
Nursing

Keywords

  • Advance care planning
  • randomized controlled trial
  • dementia
  • family caregivers

Cite this

Brazil, Kevin ; Carter, Gillian ; Cardwell, Chris ; Clarke, Mike ; Hudson, Peter ; Froggatt, Katherine ; McLaughlin, Dorry ; Passmore, Peter ; Kernohan, W.George. / Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial. In: Palliative Medicine. 2018 ; Vol. 32, No. 3. pp. 603-612.
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Brazil, K, Carter, G, Cardwell, C, Clarke, M, Hudson, P, Froggatt, K, McLaughlin, D, Passmore, P & Kernohan, WG 2018, 'Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial', Palliative Medicine, vol. 32, no. 3, pp. 603-612. https://doi.org/10.1177/0269216317722413

Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial. / Brazil, Kevin; Carter, Gillian; Cardwell, Chris; Clarke, Mike; Hudson, Peter; Froggatt, Katherine; McLaughlin, Dorry; Passmore, Peter; Kernohan, W.George.

In: Palliative Medicine, Vol. 32, No. 3, 01.03.2018, p. 603-612.

Research output: Contribution to journalArticle

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T1 - Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial

AU - Brazil, Kevin

AU - Carter, Gillian

AU - Cardwell, Chris

AU - Clarke, Mike

AU - Hudson, Peter

AU - Froggatt, Katherine

AU - McLaughlin, Dorry

AU - Passmore, Peter

AU - Kernohan, W.George

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N2 - BACKGROUND:In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor.AIM:To evaluate the effectiveness of advance care planning with family carers in dementia care homes.DESIGN:Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff.SETTING/PARTICIPANTS:A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions.RESULTS:The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (-10.5, 95% confidence interval: -16.4 to -4.7; p <0.001).CONCLUSION:Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.

AB - BACKGROUND:In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor.AIM:To evaluate the effectiveness of advance care planning with family carers in dementia care homes.DESIGN:Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff.SETTING/PARTICIPANTS:A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions.RESULTS:The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (-10.5, 95% confidence interval: -16.4 to -4.7; p <0.001).CONCLUSION:Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.

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KW - dementia

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