What are the barriers and facilitators to advance care planning with older people in long-term care facilities? A qualitative study.
Yuxin Zhou, Ariel Wang, Debbie Braybrook and 5 others
PMID 38379365WHAT IT FOUND
In Chinese long-term care, families and staff often avoided death talk, residents' spontaneous end-of-life wishes were interrupted, and guardians' decisions were legally uncertain.
Nurses may need to capture these talks, assess readiness, and clarify palliative options.
Key findings
01Four themes shaped advance care planning: absence of end-of-life discourse, relational decision-making, low trust and unsafe cultures, and meeting residents' psychosocial needs.
02Residents who spontaneously raised end-of-life wishes were sometimes interrupted by family members and healthcare professionals who feared causing distress.
03Participants said advance care planning conversations should be documented and supported by law or notarisation because of legal risk.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was qualitative, so it describes perceptions and does not test whether advance care planning improves care or reduces conflict. Participants were from four private long-term care facilities in one city, so views may not apply to public or rural facilities. Translation and culturally specific terms may have affected interpretation of meanings. Case vignettes and alternative terms may have introduced researchers' preconceptions about advance care planning.
Declared interests
The work was supported by Guangzhou Concord Medical Humanities Research and Education Fund and the Horizontal Research Project of Zhongda Hospital Affiliated to Southeast University. Authors declared no competing financial interests or personal relationships.
The easy way to misread this
Do not read these themes as proof that advance care planning improves end-of-life care or reduces family conflict. The study reported perceptions, not tested outcomes.