The Impact of Prior Advance Care Planning Documentation on End-of-Life Care Provision in Long-Term Care

  • Henry Y.H. Siu McMaster University http://orcid.org/0000-0002-1593-6827
  • Dawn Elston McMaster University
  • Neha Arora McMaster University
  • Amie Vahrmeyer Extendicare Assist
  • Sharon Kaasalainen McMaster University
  • Paula Chidwick William Osler Health System
  • Sayem Borhan McMaster University
  • Michelle Howard McMaster University
  • Daren K. Heyland Queen's University
Keywords: Long-term care, Advance care planning, Elderly, Substitute decision-maker

Abstract

Background

The impact of prior advance care planning (ACP) documentation on substitute decision-makers’ (SDMs) knowledge of values for end-of-life (EOL) care, and its correlation with SDM satisfaction with EOL care provision, have not been assessed in long-term care (LTC).

Methods

A cross-sectional survey of 2,595 SDMs from 27 LTC homes assessed: 1) knowledge of pre-existing ACP documentation and values for EOL care, and 2) the importance and satisfaction of EOL care provision in LTC. Knowledge of values for EOL care was compared to administrative documentation. Importance and satisfaction were plotted on a performance-importance grid. Multiple linear regression assessed whether knowledge of pre-existing ACP documentation correlated with satisfaction.

Results

The response rate was 25% (658/2,595); 69% of LTC residents had pre-existing ACP documentation. Discordance was noted between SDMs’ knowledge of values for EOL care and administrative documentation. Pre-existing knowledge of ACP documentation was not correlated with EOL care provision satisfaction. Priority areas for increasing satisfaction include illness management, SDM communication, and relationships with LTC clinicians.

Conclusions

The discordance between SDMs’ knowledge of values for EOL care and formal documentation needs to be addressed. Although pre-existing ACP documentation does not impact satisfaction, EOL care provision could be improved by targeting illness management, SDM communication, and relationships with LTC clinicians.

Author Biographies

Henry Y.H. Siu, McMaster University

Department of Family Medicine

Dawn Elston, McMaster University

Department of Family Medicine

Neha Arora, McMaster University
Department of Family Medicine
Amie Vahrmeyer, Extendicare Assist

Division of Extendicare

Sharon Kaasalainen, McMaster University

School of Nursing

 

Sayem Borhan, McMaster University
Department of Health Research Methods, Evidence, and Impact
Michelle Howard, McMaster University
Department of Family Medicine
Daren K. Heyland, Queen's University

Department of Critical Care Medicine

Published
2020-03-05
How to Cite
Siu, H. Y., Elston, D., Arora, N., Vahrmeyer, A., Kaasalainen, S., Chidwick, P., Borhan, S., Howard, M., & Heyland, D. K. (2020). The Impact of Prior Advance Care Planning Documentation on End-of-Life Care Provision in Long-Term Care. Canadian Geriatrics Journal, 23(2), 172-183. https://doi.org/10.5770/cgj.23.386
Section
Original Research