Aims To explore staff, residents and families’ experience of participating in advance care planning discussions.

Background/literature review: Within the UK, implementation of the Gold Standards Framework in Care Homes (GSFCH) programme is being promoted to develop the quality of end of life care for frail older people living/dying in care homes (DoH 2008). An integral part of this involves advance care planning (ACP) discussions. This study explored the experience of initiating and undertaking these discussions.

Methods A qualitative descriptive study was undertaken in three nursing homes implementing the GSFCH programme. Following an ACP discussion, semi-structured interviews were undertaken with the resident, their family member/s and the staff member undertaking ACP. Thematic analysis was used to identify the main categories and themes.

Results Twenty eight interviews were carried out. Five main categories arose: understanding ACP; undertaking ACP discussions; the impact of ACP discussions; use of documentation; and, relationship and rapport.

Staffs understanding of ACP varied and this affected the depth of their discussions with families and residents. The use of documentation either acted as a useful prompt or limited the discussion, blocked opportunistic cues and encouraged a ‘tick-box’ exercise. Staff had to face their fears around discussing death and dying. The assistance of a trained facilitator helped staff to develop knowledge, skills and confidence with end of life conversations. Residents were open to having ACP discussions, though the way it was introduced could impact on the result. Families found comfort that their loved ones future care had been considered.

Conclusions Care home staff need to develop the knowledge, skills and confidence to engage in discussions around end of life care. The assistance of a trained facilitator who role models this process would enable this.