title: Advance care planning for nursing home residents with dementia: policy vs. practice.
abstract: OBJECTIVE
  The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning.
  
  
  BACKGROUND
  Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning.
  
  
  METHODS
  Observational cross-sectional study in 20 nursing homes.
  
  
  METHODS
  The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families).
  
  
  METHODS
  June 2013-September 2013.
  
  
  RESULTS
  Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice.
  
  
  CONCLUSIONS
  The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice.
authors.affiliation: KU Leuven, LUCAS, Centre for Care Research and Consultancy, Belgium.
authors.forename: Sophie
authors.initials: S
authors.lastname: Ampe
authors.affiliation: KU Leuven, LUCAS, Centre for Care Research and Consultancy, Belgium.
authors.forename: Aline
authors.initials: A
authors.lastname: Sevenants
authors.affiliation: Vrije Universiteit Brussel, End-of-Life Care Research Group, Belgium.
authors.forename: Tinne
authors.initials: T
authors.lastname: Smets
authors.affiliation: KU Leuven, LUCAS, Centre for Care Research and Consultancy, Belgium.
authors.forename: Anja
authors.initials: A
authors.lastname: Declercq
authors.affiliation: KU Leuven, LUCAS, Centre for Care Research and Consultancy, Belgium.
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Audenhove
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D003704:Dementia / Q000451:nursing*; D005190:Family / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards*; D013727:Terminal Care / Q000592:standards*
keywords: advance care planning; dementia; end-of-life; nursing; nursing homes; palliative care; shared decision-making