“The Potential versus’ the Reality”: Findings of a Cross-sectional Survey Examining Health Care Professional Perspectives of Advance Care Planning for People with Dementia in Long Term Care Setting

Background: Evidence suggests ACP can improve thecare provided to people with dementia in long-term caresettings (LTCSs), facilitating their participation in caredecisions. However, few people with dementia haveengaged in ACP, despite it being advocated by internationalpolicy. The role of health care professionals is integralto addressing this deficit, therefore further understandingof their perspective is needed.Aim: To examine registered nursing home managers(RMs) knowledge & attitudes in relation to ACP for peoplewith dementia in LTCSs.Design: A cross-sectional postal survey was carried out aspart of a larger scale sequential explanatory mixed methodsstudy. An adapted survey instrument was used, developedthrough incorporation of results from an in-depthanalysis of the literature & consultation with key experts inACP & dementia. Principal component analysis was conducted,revealing 6 components.Setting/participants: All registered nursing home managersemployed by homes caring for people with dementiaacross Northern Ireland (n=178).Results: Response rate of 66% achieved(n=116). Thelevel of knowledge in relation to ACP was poor, with correspondinglow levels of confidence reported. A lack ofclarity surrounding who should lead the process was evident.Varying levels of support impacted on practice. Thepositive influence of ACP training was evident, with subsequentincreased perceived control reported. However,RMs struggle with the ethical dilemma created when outweighingthe potential benefits of ACP to the person withdementia with the desire to protect them.Conclusions: Whilst RMs recognise the potential benefitsof ACP, intention to engage is influenced by several interrelatedfactors, making implementation in practice complex.Enhanced understanding of the factors which influencetheir perspective will contribute to the developmentof future educational support and guidance, in order toimprove facilitation of ACP in this setting.