Experiences of Older Adults with Frailty Not Completing an Advance Directive: A Qualitative Study of ACP Conversations

Author:

Wan Zoe,Chan Helen Y. L.ORCID,Chiu Patrick K. C.,Lo Raymond S. K.,Cheng Hui-LinORCID,Leung Doris Y. P.ORCID

Abstract

Advance care planning (ACP) facilitates individuals to proactively make decisions on their end-of-life care when they are mentally competent. It is highly relevant to older adults with frailty because they are more vulnerable to cognitive impairment, disabilities, and death. Despite devoting effort to promoting ACP among them, ACP and advance directive completion rates remain low. This study aims to explore the experiences among frail older adults who did not complete an advance directive after an ACP conversation. We conducted a thematic analysis of audiotaped nurse-facilitated ACP conversations with frail older adults and their family members. We purposively selected ACP conversations from 22 frail older adults in the intervention group from a randomized controlled trial in Hong Kong who had ACP conversation with a nurse, but did not complete an advance directive upon completing the intervention. Three themes were identified: “Refraining from discussing end-of-life care”, “Remaining in the here and now”, and “Relinquishing responsibility over end-of-life care decision-making”. Participation in ACP conversations among frail older adults and their family members might improve if current care plans are integrated so as to increase patients’ motivation and support are provided to family members in their role as surrogate decision-makers.

Funder

Research Grants Council, The Hong Kong Special Administrative Region, China

Publisher

MDPI AG

Subject

Health, Toxicology and Mutagenesis,Public Health, Environmental and Occupational Health

Cited by 4 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Advance Care Planning in Hong Kong;Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen;2023-08

2. End-of-Life Communication Skills Training for Undergraduate Nursing Students to Address Cultural Obstacles in China;Journal of Hospice & Palliative Nursing;2023-02

3. Decision control preference for end‐of‐life care among older adults;Geriatrics & Gerontology International;2023-01-10

4. Effect of a Video-Supported Nurse-Led Advance Care Planning for Older Adults with Frailty: A Randomized Controlled Trial;New Research in Nursing - Education and Practice [Working Title];2022-11-27

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