Family perspectives on and experiences with advance care planning in nursing homes: A thematic synthesis.
Hye Ri Choi, Ho Nee Chu, Shumin Jia and 3 others
PMID 39223032WHAT IT FOUND
Families found end-of-life conversations with nursing home staff difficult but essential, viewing nurses as the primary source of comfort and continuity.
Staff initiation helped families accept impending death, while nurses' presence provided reassurance that residents' wishes were being respected.
Key findings
01Staff-initiated conversations helped families realize the resident's impending death, which they found difficult to discuss directly with the resident.
02Families acted as surrogate decision-makers, relying on their knowledge of the resident's past wishes to ensure comfort and natural death.
03Nurses were viewed as the key to end-of-life care due to their continuous presence, whereas physicians were seen as rarely available.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review lacked ethnographic studies, limiting insight into cultural aspects of ACP. Meta-synthesis may oversimplify qualitative findings by aggregating them. The nurse's role is described from the family's perspective, which may lack the detail of nurses' own accounts. Only English-language full-text articles were included.
Declared interests
The authors declare no conflict of interest. The research received no specific grant from any funding agency.
The easy way to misread this
Do not assume families can or will initiate end-of-life conversations with residents. The review shows they often rely on staff to start these discussions and need ongoing support to make surrogate decisions.