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Shanley, C., Whitmore, E., Khoo, A., Cartwright, C., Walker, A. and Cumming, R.G. (2009) Understanding How Advance Care Planning is Approached in the Residential Aged Care Setting: A Continuum Model of Practice as an Explanatory Device. Australian Journal on Ageing, 28, 211-215.

has been cited by the following article:

• TITLE: Advance Directives in the Context of Uncertain Prognosis for Residents of Nursing Homes

  AUTHORS: Beryl E. Cable-Williams, Donna M. Donna M. Wilson, Norah Keating

  KEYWORDS: Advance Care Planning, Advance Directives, Palliative Care, Nursing Homes

  JOURNAL NAME: Open Journal of Nursing, Vol.4 No.4, April 18, 2014

  ABSTRACT: This report documents the findings of a mixed-methods study focused on the advanced directives of 182 residents of three LTC facilities in southern Ontario, Canada. Although almost all had a completed advance directive within 3 months of death, most did not have a palliative designation or directive until a few days before they died. Each facility’s written Progress Notes revealed staff members usually sought additional confirmation of care preferences from residents’ substitute decision-makers within a few days of the death. It was thus common for advance directives to change from a more interventionist approach to the least interventionist approach near death. This change indicates that the meaning and significance of advance care planning and resulting advance directives must be considered in light of the processes and temporal factors involved in their completion and use within this distinct population. The relational nature of advance care planning and concern about ageism as a factor for withholding or withdrawing life support for LTC residents are considered as possible explanatory factors. These findings and their implications are described in relation to end-of-life care policies and practices in LTC facilities.