CHALLENGES IN END-OF-LIFE DECISION MAKING FOR PATIENTS IN LONG-TERM CARE SETTING: PERSPECTIVES OF HEALTH PROFESSIONALS
Method(s): Focus group interviews were conducted in December 2014 with health professionals currently working in LTC setting. The participants were divided into groups by ranks and disciplines. The homogeneity in the group and the group dynamic encouraged them to share experiences and views more freely. This strategy allows researchers to elicit diverse perspectives, needs and concerns. All interviews were audiotaped and transcribed verbatim to facilitate analysis, but confidentiality and anonymity was assured. Qualitative content analysis was performed. The study was approved by the Cluster Clinical Research Ethics Committee.
Result(s): A total of 20 participants from different disciplines were divided into six groups. They included two medical doctors, ten registered nurses, five enrolled nurses, a social worker, a physiotherapist and an occupational therapist. All of them had rich clinical experience, with an average of 21 years (range: 10-30 years), but their working experience in their current unit varied from 1 to 24 years. Around one third of them had attended training workshops or seminars about palliative or EoL care. From their accounts of care experiences, the major challenges in EoL decision making in LTC setting are related to right timing, preparedness of health professionals, mental capacity of patients, and readiness of family.
Conclusion(s): There was consensus across participants of different disciplines that advance care planning (ACP) for patients in LTC setting is imperative because they generally have progressive debilitating conditions. However, a range of concerns were also identified that may hinder the planning process. For example, when is the appropriate time to plan for EoL care given that many patients have stayed in the care facility with stable condition for a period of time, who can take the lead in the EoL decision making, what would the patients want for their EoL care, how to prepare the family members for the EoL decision making, and how to align the care with the care goal. The findings of the study suggest that a number of strategies, including staff education, family-centred ACP programme, interdisciplinary communication, and tailored model of care delivery, are needed to be complementary to support health professionals to improve EoL decision making for patients in LTC setting.