Hospice UK Abstract
Title:
Conversations on living and dying: Facilitating advance care planning for older people with frailty
Background:
Older people living with frailty (older people)often receive suboptimal end-of-life care1. Frequently under- or over-treated, older peopleexperience inappropriate hospital admissions and procedures2,3. Most die in hospital despite 81% wishing to die at home4. Advance care planning (ACP), a structured conversation between professionals and someone nearing the end-of-life, enables people to discuss and document what matters to them regardingtheir future care5. Facilitating informed decision-making regarding ACP means people are more likely to receive person-centred end-of-life care6.
Multiple challenges mean that ACP is relatively uncommon forolder people7,8. Consequently, priorities are often not discussed prior to significant deterioration9, leading to crisis decision-making which older peoplemay not have capacity for10. Current initiatives encompass aspects of ACP. However, there is no systematic, agreed format or training for health and social care professionals (professionals) that supports older people to articulate their broader end-of-life wishes on an ongoing basis11-13.
Aims:
Thisfour-phase study aims to develop a relevant ACP intervention in collaboration with older people, their carers and professionals. Phase one,presented here, aims to establish current evidence regarding the components and implementation of ACP for community-dwelling older people, and use this to develop a theoretical model which will underpin the remaining study phases.
Methods:
An integrative reviewwill be conducted using CINAHL, Embase, Ovid Medline, PsycINFO, andNHS evidencedatabases, grey literature, and hand-searching. Paper selection will be verified by the research teamand critically appraised using relevant systematic tools. Whittemore and Knafl’s14method will be used to develop an integrated, theoretical model. This will include data mapping against COM-B, a model of behaviour change often used in intervention development, to identify relevant target behaviours15.
Results and conclusions:
The study began in January 2017. Phase one is currently underway and its results, conclusions and recommendations will be presented at this conference.
References
(1) Lloyd A, Kendall M, Carduff E, Cavers D, Kimbell B, Murray SA. Why do older people get less palliative care than younger people? European Journal of Palliative Care 2016;23(3):132-137.
(2) Houben CH, Spruit MA, Groenen MT, Wouters EF, Janssen DJ. Efficacy of advance care planning: a systematic review and meta-analysis. Journal of the American Medical Directors Association 2014;15(7):477-489.
(3) Hunt KJ, Shlomo N, Addington-Hall J. End-of-life care and preferences for place of death among the oldest old: results of a population-based survey using VOICES–short form. J Palliat Med 2014;17(2):176-182.
(4) Office for National Statistics. National Survey of Bereaved People (VOICES): England, 2015. 2016; , 23 March 2017.
(5) Thomas K, Lobo B. Advance care planning in end of life care. : Oxford University Press; 2011.
(6) National Council for Palliative Care. Capacity, care planning and advance care planning in life limiting illness: A Guide for Health and Social Care Staff. 2011:
(7) Musa I, Seymour J, Narayanasamy MJ, Wada T, Conroy S. A survey of older peoples' attitudes towards advance care planning. Age Ageing 2015 May;44(3):371-376.
(8) Pollock K, Wilson E. Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: a qualitative study of care at the end of life. 2015 Jul.
(9) Sharp T, Moran E, Kuhn I, Barclay S. Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis. Br J Gen Pract 2013 Oct;63(615):e657-68.
(10) Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The Lancet 2013;381(9868):752-762.
(11) Brinkman-Stoppelenburg A, Rietjens JA, van der Heide A. The effects of advance care planning on end-of-life care: a systematic review. Palliat Med 2014;28(8):1000-1025.
(12) Johnson S, Butow P, Kerridge I, Tattersall M. Advance care planning for cancer patients: a systematic review of perceptions and experiences of patients, families, and healthcare providers. Psycho‐Oncology 2015.
(13) Weathers E, O’Caoimh R, Cornally N, Fitzgerald C, Kearns T, Coffey A, et al. Advance care planning: A systematic review of randomised controlled trials conducted with older adults. Maturitas2016;91:101-109.
(14) Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs 2005;52(5):546-553.
(15) Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science 2011;6(1):42.