Facilitated case conferences on end-of-life care for persons with advanced dementia-a qualitative study of interactions between long-term care clinicians and family members.

Francisco, MC; Lane, H; Luckett, T; Disalvo, D; Pond, D; Mitchell, G; Chenoweth, L; Phillips, J; Beattie, E; Luscombe, G; Goodall, S; Agar, M

Facilitated case conferences on end-of-life care for persons with advanced dementia-a qualitative study of interactions between long-term care clinicians and family members.

Francisco, MC Lane, H Luckett, T

Disalvo, D

Pond, D Mitchell, G Chenoweth, L Phillips, J

Beattie, E Luscombe, G Goodall, S

Agar, M

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Publisher:: Oxford University Press
Publication Type:: Journal Article
Citation:: Age and Ageing, 2022, 51, (2), pp. 1-7
Issue Date:: 2022-02-02

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Field	Value	Language
dc.contributor.author	Francisco, MC
dc.contributor.author	Lane, H
dc.contributor.author	Luckett, T https://orcid.org/0000-0001-6121-5409
dc.contributor.author	Disalvo, D https://orcid.org/0000-0001-9179-7702
dc.contributor.author	Pond, D
dc.contributor.author	Mitchell, G
dc.contributor.author	Chenoweth, L
dc.contributor.author	Phillips, J https://orcid.org/0000-0002-3691-8230
dc.contributor.author	Beattie, E
dc.contributor.author	Luscombe, G
dc.contributor.author	Goodall, S https://orcid.org/0000-0001-6611-6565
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119
dc.date.accessioned	2022-09-29T06:23:08Z
dc.date.available	2022-09-29T06:23:08Z
dc.date.issued	2022-02-02
dc.identifier.citation	Age and Ageing, 2022, 51, (2), pp. 1-7
dc.identifier.issn	0002-0729
dc.identifier.issn	1468-2834
dc.identifier.uri	http://hdl.handle.net/10453/162177
dc.description.abstract	BACKGROUND: Prognostic uncertainty and the need for proxy decision-making owing to cognitive impairment in advanced dementia, adds complexity to end-of-life care planning within the long-term care setting. Case conferences provide a structure to facilitate difficult conversations and an opportunity for family and clinicians to engage in prospective planning, and reach agreement on goals of end-of-life care. OBJECTIVE: To explore interactions between multidisciplinary healthcare clinicians and families during facilitated case conferences on end-of-life care for residents with advanced dementia. METHODS: A qualitative approach was used. Transcripts of audio-recorded case conferences facilitated by a trained registered nurse were coded by two independent researchers and analysed inductively. Transcripts were selected from an available pool until thematic saturation was reached. Emerging themes were confirmed with the wider research group. RESULTS: Thematic saturation was reached after 25 transcripts. An overarching theme concerned the ways in which clinicians and families bridged medical and person-centred perspectives. Subthemes included: details of day-to-day care versus establishing overall goals of care; expression of emotion versus retreat from emotion; and missed opportunities versus expressed cues. Successful facilitation served to 'bridge the gap' between family and clinicians. CONCLUSION: Facilitation of case conferences for residents with advanced dementia should focus on ensuring that: clinicians do not miss opportunities to discuss end-of-life care; discussions on the minutiae of care regularly return to the resident's broader goals of care; and information on dementia and treatments provided by clinicians is integrated with advice by family members regarding the resident's premorbid values and likely preferences.
dc.format	Print
dc.language	eng
dc.publisher	Oxford University Press
dc.relation.ispartof	Age and Ageing
dc.relation.isbasedon	10.1093/ageing/afab270
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services, 1701 Psychology
dc.subject.classification	Geriatrics
dc.subject.mesh	Dementia
dc.subject.mesh	Family
dc.subject.mesh	Humans
dc.subject.mesh	Long-Term Care
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Qualitative Research
dc.subject.mesh	Terminal Care
dc.subject.mesh	Dementia
dc.subject.mesh	Family
dc.subject.mesh	Humans
dc.subject.mesh	Long-Term Care
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Qualitative Research
dc.subject.mesh	Terminal Care
dc.subject.mesh	Humans
dc.subject.mesh	Dementia
dc.subject.mesh	Long-Term Care
dc.subject.mesh	Terminal Care
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Family
dc.subject.mesh	Qualitative Research
dc.title	Facilitated case conferences on end-of-life care for persons with advanced dementia-a qualitative study of interactions between long-term care clinicians and family members.
dc.type	Journal Article
utslib.citation.volume	51
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
utslib.for	1701 Psychology
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2022-09-29T06:23:07Z
pubs.issue	2
pubs.publication-status	Published
pubs.volume	51
utslib.citation.issue	2

Abstract:

BACKGROUND: Prognostic uncertainty and the need for proxy decision-making owing to cognitive impairment in advanced dementia, adds complexity to end-of-life care planning within the long-term care setting. Case conferences provide a structure to facilitate difficult conversations and an opportunity for family and clinicians to engage in prospective planning, and reach agreement on goals of end-of-life care. OBJECTIVE: To explore interactions between multidisciplinary healthcare clinicians and families during facilitated case conferences on end-of-life care for residents with advanced dementia. METHODS: A qualitative approach was used. Transcripts of audio-recorded case conferences facilitated by a trained registered nurse were coded by two independent researchers and analysed inductively. Transcripts were selected from an available pool until thematic saturation was reached. Emerging themes were confirmed with the wider research group. RESULTS: Thematic saturation was reached after 25 transcripts. An overarching theme concerned the ways in which clinicians and families bridged medical and person-centred perspectives. Subthemes included: details of day-to-day care versus establishing overall goals of care; expression of emotion versus retreat from emotion; and missed opportunities versus expressed cues. Successful facilitation served to 'bridge the gap' between family and clinicians. CONCLUSION: Facilitation of case conferences for residents with advanced dementia should focus on ensuring that: clinicians do not miss opportunities to discuss end-of-life care; discussions on the minutiae of care regularly return to the resident's broader goals of care; and information on dementia and treatments provided by clinicians is integrated with advice by family members regarding the resident's premorbid values and likely preferences.

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http://hdl.handle.net/10453/162177