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.