‘We have no crystal ball’ - advance care planning at nursing homes from the perspective of nurses and physicians

AbstractObjective: To investigate clinicians’ perspectives on the factors that shape the process of advance care planning in a nursing home context.Design: Interviews. Latent qualitative content analysis.Setting: Nine nursing homes in Sweden.Subjects: 14 physicians and 11 nurses working at nursing homes.Main outcome measures: Participants’ views on advance care planning (ACP) at nursing homes.Results: The analysis of the interviews resulted in four manifest categories: Exploration of preferences and views, e.g. exploring patient wishes regarding end-of-life issues and restrictions in care at an early stage, and sensitivity to patient’s readiness to discuss end-of-life issues; Integration of preferences and views, e.g. integration of patient’s preferences and staff’s and family member’s views; Decision & documentation of the ACP, e.g. clear documentation in patient’s medical records that are up-to-date and available for staff caring for the patient, and Implementation & re-evaluation of the ACP, e.g. nurse...