Implementing and Evaluating Online Advance Care Planning Training in UK Nursing Homes During COVID-19: Findings from the Necessary Discussions Multi-site Case Study Project

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2022 May 13

PMID 35562712

Authors

Emily Cousins

Nancy Preston

Julie Doherty

Sandra Varey

Andrew Harding

Adrienne McCann

Karen Harrison Dening

Anne Finucane

Gillian Carter

Gary Mitchell

Kevin Brazil

Affiliations

Soon will be listed here.

Abstract

Background: Advance care planning in nursing homes is important to ensure the wishes and preferences of residents are recorded, especially during the COVID-19 pandemic. However, care staff and family members frequently report feeling unprepared for these conversations. More resources are needed to support them with these necessary discussions. This research aimed to develop, implement and evaluate a website intervention for care staff and family members to provide training and information about advance care planning during COVID-19.

Methods: The research was a primarily qualitative case study design, comprising multiple UK nursing home cases. Data collection included semi-structured interviews with care staff and family members which were coded and analysed thematically. A narrative synthesis was produced for each case, culminating in a thematic cross-case analysis of the total findings. Theoretical propositions were refined throughout the research.

Results: Eight nursing homes took part in the study, involving 35 care staff and 19 family members. Findings were reported according to the RE-AIM framework which identified the reach, effectiveness, adoption, implementation and maintenance of the intervention. Themes included: website content that was well received; suggestions for improvement; implementation barriers and facilitators; examples of organisational and personal impact.

Conclusions: Four theoretical propositions relating to advance care planning in nursing homes are presented, relating to: training and information needs, accessibility, context, and encouraging conversations. Implications for practice and training include an awareness of diverse learning styles, re-enforcing the right to be involved in advance care planning and encouraging opportunities for facilitated discussion.

Trial Registration: ISRCTN registry (ID 18003630 ) on 19.05.21.

Citing Articles

Dying in residential care homes during the early COVID-19 pandemic: a qualitative interview study.

Preston N, Cockshott Z, Russell S, Stocker R, Knight J, Mason S BMC Geriatr. 2025; 25(1):126.

PMID: 39994535 PMC: 11854402. DOI: 10.1186/s12877-025-05779-y.

Family perspectives on and experiences with advance care planning in nursing homes: A thematic synthesis.

Choi H, Chu H, Jia S, Liu X, Wang T, Lin C J Adv Nurs. 2024; 81(3):1116-1129.

PMID: 39223032 PMC: 11810491. DOI: 10.1111/jan.16383.

Enhancing COVID-19 Knowledge among Nursing Students: A Quantitative Study of a Digital Serious Game Intervention.

McConnell H, Duncan D, Stark P, Anderson T, McMahon J, Creighton L Healthcare (Basel). 2024; 12(11).

PMID: 38891141 PMC: 11171738. DOI: 10.3390/healthcare12111066.

Heart failure in nursing homes: A scoping review of educational interventions for optimising care provision.

McMahon J, Thompson D, Cameron J, Brown Wilson C, Hill L, Tierney P Int J Nurs Stud Adv. 2024; 6:100178.

PMID: 38746815 PMC: 11080315. DOI: 10.1016/j.ijnsa.2024.100178.

Long term care facilities in England during the COVID-19 pandemic-a scoping review of guidelines, policy and recommendations.

Collingridge Moore D, Garner A, Cotterell N, Harding A, Preston N BMC Geriatr. 2024; 24(1):394.

PMID: 38702669 PMC: 11069159. DOI: 10.1186/s12877-024-04867-9.

References

Steel A, Owen L . Advance care planning: the who, what, when, where and why. Br J Hosp Med (Lond). 2020; 81(2):1-6. DOI: 10.12968/hmed.2019.0396. View

King D, Glasgow R, Leeman-Castillo B . Reaiming RE-AIM: using the model to plan, implement, and evaluate the effects of environmental change approaches to enhancing population health. Am J Public Health. 2010; 100(11):2076-84. PMC: 2951937. DOI: 10.2105/AJPH.2009.190959. View

Stone L, Kinley J, Hockley J . Advance care planning in care homes: the experience of staff, residents, and family members. Int J Palliat Nurs. 2013; 19(11):550-7. DOI: 10.12968/ijpn.2013.19.11.550. View

Gordon A, Goodman C, Achterberg W, Barker R, Burns E, Hanratty B . Commentary: COVID in care homes-challenges and dilemmas in healthcare delivery. Age Ageing. 2020; 49(5):701-705. PMC: 7239229. DOI: 10.1093/ageing/afaa113. View

Frey R, Balmer D, Robinson J, Boyd M, Gott M . What factors predict the confidence of palliative care delivery in long-term care staff? A mixed-methods study. Int J Older People Nurs. 2019; 15(2):e12295. DOI: 10.1111/opn.12295. View

Rietjens J, Sudore R, Connolly M, van Delden J, Drickamer M, Droger M . Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care. Lancet Oncol. 2017; 18(9):e543-e551. DOI: 10.1016/S1470-2045(17)30582-X. View

Conroy S, Fade P, Fraser A, Schiff R . Advance care planning: concise evidence-based guidelines. Clin Med (Lond). 2009; 9(1):76-9. PMC: 5922644. DOI: 10.7861/clinmedicine.9-1-76. View

Sudore R, Lum H, You J, Hanson L, Meier D, Pantilat S . Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel. J Pain Symptom Manage. 2017; 53(5):821-832.e1. PMC: 5728651. DOI: 10.1016/j.jpainsymman.2016.12.331. View

Anstey S, Powell T, Coles B, Hale R, Gould D . Education and training to enhance end-of-life care for nursing home staff: a systematic literature review. BMJ Support Palliat Care. 2016; 6(3):353-61. PMC: 5013161. DOI: 10.1136/bmjspcare-2015-000956. View

10.

Byron G, Ziedonis D, McGrath C, Frazier J, deTorrijos F, Fulwiler C . Implementation of Mindfulness Training for Mental Health Staff: Organizational Context and Stakeholder Perspectives. Mindfulness (N Y). 2015; 6(4):861-872. PMC: 4612531. DOI: 10.1007/s12671-014-0330-2. View

11.

Hanson E, Magnusson L . Views of family carers and older people of information technology. Br J Nurs. 2002; 11(12):827-31. DOI: 10.12968/bjon.2002.11.12.10306. View

12.

Chambers M, Connor S . User-friendly technology to help family carers cope. J Adv Nurs. 2002; 40(5):568-77. DOI: 10.1046/j.1365-2648.2002.02415.x. View

13.

Tobin G, Begley C . Methodological rigour within a qualitative framework. J Adv Nurs. 2004; 48(4):388-96. DOI: 10.1111/j.1365-2648.2004.03207.x. View

14.

Luck L, Jackson D, Usher K . Case study: a bridge across the paradigms. Nurs Inq. 2006; 13(2):103-9. DOI: 10.1111/j.1440-1800.2006.00309.x. View

15.

Seal M . Patient advocacy and advance care planning in the acute hospital setting. Aust J Adv Nurs. 2007; 24(4):29-36. View

16.

Palinkas L, Aarons G, Horwitz S, Chamberlain P, Hurlburt M, Landsverk J . Mixed method designs in implementation research. Adm Policy Ment Health. 2010; 38(1):44-53. PMC: 3025112. DOI: 10.1007/s10488-010-0314-z. View

17.

Rosen J, Mulsant B, Kollar M, Kastango K, Mazumdar S, Fox D . Mental health training for nursing home staff using computer-based interactive video: a 6-month randomized trial. J Am Med Dir Assoc. 2003; 3(5):291-6. DOI: 10.1097/01.JAM.0000027201.90817.21. View

18.

Harding A, Preston N, Doherty J, Cousins E, Varey S, McCann A . Developing and evaluating online COVID-centric advance care planning training and information resources for nursing staff and family members in nursing homes: the necessary discussions study protocol. BMC Geriatr. 2021; 21(1):456. PMC: 8350283. DOI: 10.1186/s12877-021-02398-1. View

19.

Brazil K, Carter G, Cardwell C, Clarke M, Hudson P, Froggatt K . Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial. Palliat Med. 2017; 32(3):603-612. DOI: 10.1177/0269216317722413. View

20.

Paparini S, Green J, Papoutsi C, Murdoch J, Petticrew M, Greenhalgh T . Case study research for better evaluations of complex interventions: rationale and challenges. BMC Med. 2020; 18(1):301. PMC: 7652677. DOI: 10.1186/s12916-020-01777-6. View