Staff and Proxy Views of Multiple Family Member Involvement in Decision Making for Nursing Home Residents With Advanced Dementia.
Ashley Roach, Anita Hendrix Rogers, Susan L Mitchell and 2 others
PMID 37235711WHAT IT FOUND
Nursing home staff mostly saw multiple family members as conflict, while proxies mostly saw them as support.
Staff said family disagreement often pushed care toward aggressive interventions, and advance directives helped follow the resident's wishes.
Key findings
01Nursing home staff and proxies both saw multiple family members as a source of conflict and support, but staff more often described conflict while proxies more often described support.
02When families could not agree, staff reported they often chose more aggressive or burdensome care rather than palliative care; staff also reported an advance directive helped support the primary proxy's decisions.
03Some nursing home staff described Black families as larger and more conflict-prone, while some proxies feared being blamed by relatives for choosing palliative care.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The study was done in 14 nursing homes in two U.S. regions, so views from other regions or cultures may differ. Participants were not explicitly asked about family dynamics, so the analysis relied on mentions in interviews about end-of-life decisions. It reports perceptions, not tested interventions or patient outcomes.
Declared interests
The authors reported no personal conflicts. The article is listed as supported by NIH extramural research funding.
The easy way to misread this
Do not conclude that encouraging advance directives or mediating family conflict improves resident outcomes. This study reports staff and proxy perceptions, not tested interventions or patient outcomes.