"We Want to Sign It, But We Can't Do It": Results From a Qualitative Pilot Study of Experiences Related to Advance Directives Among Families of Older Residents in a Long-term Care Facility.
Hsin-Tzu Sophie Lee, Chia-Ling Yang, Ting-Ru Chen and 2 others
PMID 34282074WHAT IT FOUND
Families of nursing home residents often avoided signing advance directives because they waited for the resident or whole family, feared being unfilial or abandoned, and thought the timing was wrong.
Separate conversations with resident and family are proposed.
Key findings
01Six relatives of conscious residents said they could not sign before the resident and feared it would look unfilial or inappropriate.
02Relatives often treated signing as a family group matter, and some said no advance directive was needed because the family had already reached an unspoken consensus to let the resident have a good death.
03Relatives delayed signing because they feared the resident would be abandoned, or because they thought the resident's condition and medical technology made the timing uncertain.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single nursing home and participants only from Hokkien Taiwanese, so findings may not apply to other facilities, cultures, or residents. Small purposive sample of 20 relatives, not residents, so it cannot show how common these reasons are or what residents would choose. Qualitative interviews describe experiences and themes; they do not test whether advance directive conversations, separate staff conversations, or family mediation change signing.
Declared interests
The authors declared no conflicts of interest. No funding source is reported.
The easy way to misread this
Do not conclude that nurses should pressure families to sign advance directives, or that separate conversations will make them sign. The study describes why families hesitated. It did not test any communication method or show that signing increased.