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Implementation of an Advance Care Planning Intervention in Nursing Homes: An International Multiple Case Study

K. Brazil, C. Walshe, J. Doherty, AJE. Harding, N. Preston, L. Bavelaar, N. Cornally, P. Di Giulio, S. Gonella, I. Hartigan, C. Henderson, S. Kaasalainen, M. Loucka, T. Sussman, K. Vlckova, JT. van der Steen, mySupport Study Group

. 2024 ; 64 (6) : . [pub] 20240601

Jazyk angličtina Země Spojené státy americké

Typ dokumentu časopisecké články, práce podpořená grantem

Perzistentní odkaz   https://www.medvik.cz/link/bmc24013784

Grantová podpora
EU Joint Programme-Neurodegenerative Disease Research
161462 CIHR - Canada
8F19005 Ministry of Education, Youth and Sport
733051084 ZonMw the Netherlands Organisation for Health Research and Development
JPNDHSC-2018-002 Health Research Board - Ireland
AS-IGF-17-001 Alzheimer's Society - United Kingdom

BACKGROUND AND OBJECTIVES: The inability of individuals in the advanced stage of dementia to communicate about preferences in care at the end-of-life poses a challenge for healthcare professionals and family carers. The proven effective Family Carer Decision Support intervention has been designed to inform family carers about end-of-life care options available to a person living with advanced dementia. The objectives of the mySupport study were to adapt the application of the intervention for use in different countries, assess impact on family satisfaction and decision-making, and identify costs and supportive conditions for the implementation of the intervention. RESEARCH DESIGN AND METHODS: A multiple-case study design was chosen where the nursing home was the case. Nursing homes were enrolled from six countries: Canada, Czech Republic, Italy, Netherlands, Republic of Ireland, and United Kingdom. RESULTS: Seventeen cases (nursing homes) participated, with a total of 296 interviews completed including family carers, nursing home staff, and health providers. Five themes relevant to the implementation of the intervention were identified: supportive relationships; committed staff; perceived value of the intervention; the influence of external factors on the nursing home; and resource impact of delivery. DISCUSSION AND IMPLICATIONS: There is a commonality of facilitators and barriers across countries when introducing practice innovation. A key learning point was the importance of implementation being accompanied by committed and supported nursing home leadership. The nursing home context is dynamic and multiple factors influence implementation at different points of time.

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