title: Advance care planning in care homes: the experience of staff, residents, and family members.
abstract: BACKGROUND
  In 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 and dying in care homes. Advance care planning (ACP) discussions are an integral part of this. This study explored experiences of initiating and completing these discussions in homes undertaking the GSFCH.
  
  
  METHODS
  A qualitative descriptive study was carried out in three nursing care homes implementing the GSFCH programme. Following an ACP discussion, 28 semi-structured interviews were conducted with the resident, a family member, and the staff member who undertook the ACP. Content analysis was then conducted.
  
  
  RESULTS
  Three main categories of findings emerged: understanding ACP, undertaking ACP discussions, and impact of and reactions to ACP discussions. Staff understanding of ACP varied, affecting the depth of their discussions. Documentation was either a useful prompt or limited the discussion, blocking opportunistic cues and encouraging a 'tick-box' exercise. Residents were open to ACP, although the way it was introduced could affect the results. Families were comforted that the resident's future care had been considered. Education was identified as being important, and role modelling ACP enabled a member of staff to develop their skills and confidence in it.
  
  
  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 should be explored.
authors.affiliation: Research Assistant/Care Home Facilitator, Care Home Project Team, St Christophers Hospice, Sydenham, London.
authors.forename: Louisa
authors.initials: L
authors.lastname: Stone
authors.forename: Julie
authors.initials: J
authors.lastname: Kinley
authors.forename: Jo
authors.initials: J
authors.lastname: Hockley
mesh_terms: D032722:Advance Care Planning; D005190:Family / Q000523:psychology*; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D009735:Nursing Homes / Q000458:organization & administration*; D009740:Nursing Staff / Q000523:psychology*; D006113:United Kingdom