Introduction Advance care planning (ACP) has been shown to promote care that is coherent with patient wishes, however retaining decision making capacity (DMC) is a precondition for traditional ACP models. Alternative models of ACP are needed for use with and on behalf of people lacking and who no longer have DMC. We have developed a model of ACP by proxy (ACPbp) specifically for use with residential aged care facility residents (RACF) who no longer have DMC.
Aim This study aimed to test the acceptability and feasibility of this ACPbp intervention through a pilot study, and to explore the impact on health care proxies’ decisional conflict and experience of the intervention.
Method Data collection took place in four RACFs in French-speaking Switzerland. Health care proxies who participated in the intervention (n=14) participated in semi-structured interviews and completed the decisional conflict scale before and ACP-bp completion. Interviews were transcribed verbatim and analysed thematically.
Results Participants in the research project represent around half of the participants invited to participate- reasons for decline included previous bad experience with research, emotional toll of the family situation and time constraints. Health care proxies reported that the intervention was an opportunity to establish or reinforce communication with the RACF personnel and physician. They appreciated the opportunity to discuss the resident’s life and values in order to give the RACF staff a better picture of the person. While some reported that discussions about the resident’s health status was difficult, they recognised the need for a timely and open discussion. Documentation of wishes was described as necessary but confronting to see the care that would not be administered in case of emergency.
Discussion The intervention was generally well accepted by proxies and provides an important basis for advance care planning for people who no longer have decision making capacity.
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