Advance Care Planning (ACP) is crucial in long-term care (LTC) settings, ensuring residents’ preferences are honored as their health evolves. To understand how to best facilitate ACP in LTC, focus groups were conducted with 32 staff members from a long-term care facility, including clinical and non-clinical personnel. These discussions, combined with a content analysis of 32 existing ACP tools, shed light on the essential features of effective Care Planning Tools For Long Term Care. This article synthesizes these findings to provide insights into developing and utilizing care planning tools that truly meet the needs of residents, families, and staff in the long term care context.
Key Insights from Focus Groups on Care Planning Tools
Staff participants across various focus groups highlighted several crucial aspects for the usability of care planning tools for long term care. A primary consensus was the need for tools that offer clear information and guidance on the ACP process itself. Staff emphasized that care planning tools should not only prompt discussions but also educate users about the importance of ACP and clarify the roles of decision-makers. Participants felt that including information about the potential consequences of not having an advance care plan could be a powerful motivator. Furthermore, staff valued tools that provide practical support for initiating ACP conversations, suggesting that “good conversation starters” and “specific examples and prompts” are invaluable in making these sometimes sensitive discussions more approachable and productive. Examples of effective prompts included asking residents about their top end-of-life preferences or their wishes regarding hospitalization, striking a balance between specificity and open-endedness to encourage meaningful reflection.
A significant finding from the focus groups was the emphasis on psychosocial considerations within care planning tools. While acknowledging the importance of medical information, staff felt that tools with a purely medical focus were insufficient for the holistic needs of LTC residents. Participants stressed that key concerns in long term care often revolve around psychosocial aspects such as fear of dying alone, maintaining quality of life, and not being a burden to family. The consensus was that effective care planning tools for long term care must incorporate psychosocial dimensions alongside medical concerns. This broader scope ensures that a wider range of staff can contribute to the ACP process and addresses topics of paramount importance to residents and their families. Relevant psychosocial topics identified included preferences for family involvement, beliefs about quality of life and death, desired environmental conditions, and religious or spiritual preferences.
Regarding the format and delivery of care planning tools, focus group participants expressed a preference for diverse options and paper-based formats. Recognizing the heterogeneity of the LTC resident population, staff indicated that a single tool is unlikely to suit everyone. Instead, they advocated for a selection of care planning tools, allowing for a tailored approach based on individual resident and family needs. The availability of hard copies was deemed essential to overcome barriers related to computer access and literacy. Additionally, participants consistently emphasized the need for tools of moderate length, cautioning against overly lengthy documents that could be overwhelming for residents, families, and staff alike.
Content Analysis of Existing Care Planning Tools: Identifying Gaps
A comprehensive content analysis of 32 care planning tools further substantiated the insights from the focus groups. The initial search identified 611 tools, but after applying exclusion criteria, primarily for tools with a sole medical focus or non-paper-based formats, 32 tools were retained for in-depth review. This selection process underscores the relative scarcity of care planning tools that are both psychosocially comprehensive and readily accessible in long term care settings.
The analysis revealed that while most tools (67%) incorporated visual elements like photos or graphics and offered illustrative scenarios (56%), the length varied considerably, ranging from concise 3-page guides to extensive 102-page workbooks. A substantial proportion (34%) were longer than 25 pages, potentially posing a usability challenge in busy long term care environments.
Encouragingly, the vast majority of tools (94%) prompted psychosocial reflections, often through questions about quality of life, values, and beliefs related to death and dying. Specific reflections on preferred location of death were common (84%), and many tools (69%) also touched upon comfort preferences and desired company during final days. However, a notable gap emerged in guidance on communication and documentation of psychosocial preferences. While all tools emphasized the importance of communication, fewer provided concrete tips on initiating these conversations (44%) or supporting substitute decision-makers (22%). Even fewer tools (17%) specifically encouraged discussing psychosocial preferences, and only a small fraction (22%) offered a formal mechanism for documenting these directives.
Optimizing Care Planning Tools for Long Term Care
The combined findings from focus groups and content analysis provide valuable direction for enhancing care planning tools for long term care. To maximize their effectiveness and usability, these tools should prioritize the following:
- Comprehensive Information and Guidance: Clearly explain the ACP process, its importance in long term care, and the roles of all involved parties.
- Psychosocial Focus: Integrate psychosocial considerations alongside medical aspects, addressing residents’ values, preferences, and quality of life concerns.
- Practical Conversation Support: Include concrete conversation starters, prompts, and examples to facilitate ACP discussions between staff, residents, and families.
- Diverse Options and Paper-Based Accessibility: Offer a range of tools to accommodate diverse needs and ensure paper-based formats are readily available.
- Concise and User-Friendly Format: Maintain a moderate length and clear, accessible language to avoid overwhelming users.
- Enhanced Communication Guidance: Provide practical tips for initiating and navigating ACP conversations, particularly regarding psychosocial preferences.
- Documentation of Psychosocial Directives: Incorporate mechanisms for formally documenting residents’ psychosocial wishes and preferences.
By incorporating these key features, care planning tools can become more effective instruments in promoting person-centered long term care, ensuring that residents’ voices are heard and their preferences are honored throughout their care journey. The development and implementation of such optimized tools are essential to advance the quality of end-of-life care in long term care settings.
