title: Evaluating the systematic implementation of the 'Let Me Decide' advance care planning programme in long term care through focus groups: staff perspectives.
abstract: BACKGROUND
  The 'Let Me Decide' Advance Care Planning (LMD-ACP) programme offers a structured approach to End-of-Life (EoL) care planning in long-term care for residents with and without capacity to complete an advance care directive/plan. The programme was implemented in three homes in the South of Ireland, with a view to improving quality of care at end of life. This paper will present an evaluation of the systematic implementation of the LMD-ACP programme in the homes.
  
  
  METHODS
  Focus groups were conducted with 15 Clinical Nurse Managers and two Directors of Nursing where the programme had been implemented. A semi-structured topic guide was used to direct questions that addressed implementation process, challenges implementing advance care planning, advantages/disadvantages and recommendations for the future. Data was analysed using manifest content analysis.
  
  
  RESULTS
  Five key categories emerged, with 16 corresponding subcategories. These subcategories emerged as a result of 37 codes. Key benefits of the programme included enhancing communication, changing the care culture, promoting preference-based care and avoiding crisis decision making. Establishing capacity among residents and indecision were among the main challenges reported by staff.
  
  
  CONCLUSIONS
  A number of recommendations were proposed by participants and included multi-disciplinary team involvement, and a blended approach to education on the topic. According to participants relationships with residents deepened, there was a more open and honest environment with family, end of life care focused more on symptom management, comfort and addressing spiritual care needs as opposed to crisis decision making and family conflict.
  
  
  CONCLUSIONS
  The introduction of the LMD-ACP programme enhanced the delivery of care in the long-term care sites and led to a more open and positive care environment.
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland. n.cornally@ucc.ie.|Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland. n.cornally@ucc.ie.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cornally
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland. ciaramcglade@gmail.com.|Health Service Executive, Mallow General Hospital, Mallow, Cork, Ireland. ciaramcglade@gmail.com.
authors.forename: Ciara
authors.initials: C
authors.lastname: McGlade
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland. e.weathers@ucc.ie.|Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland. e.weathers@ucc.ie.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Weathers
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland. edel.daly66@gmail.com.
authors.forename: Edel
authors.initials: E
authors.lastname: Daly
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland. carol.fitzgerald@ucc.ie.
authors.forename: Carol
authors.initials: C
authors.lastname: Fitzgerald
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland. rocaoimh@hotmail.com.|Health Research Board Clinical Research Facility Galway, National University of Ireland, Geata an Eolais, University Road, Galway, Ireland. rocaoimh@hotmail.com.
authors.forename: Rónán
authors.initials: R
authors.lastname: O'Caoimh
authors.affiliation: Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland. a.coffey@ucc.ie.
authors.forename: Alice
authors.initials: A
authors.lastname: Coffey
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland. w.molloy@ucc.ie.
authors.forename: D William
authors.initials: DW
authors.lastname: Molloy
mesh_terms: D032722:Advance Care Planning; D003657:Decision Making; D017144:Focus Groups; D006801:Humans; D007494:Ireland; D008134:Long-Term Care / Q000379:methods* / Q000592:standards; D011787:Quality of Health Care; D013727:Terminal Care / Q000379:methods* / Q000592:standards