Process and impact of an advance care planning intervention evaluated by bereaved surrogate decision-makers of dialysis patients.
Few studies have examined the process and impact of an advance care planning intervention experienced by surrogate decision-makers of dialysis patients.



To explore the perspectives of the bereaved surrogates of dialysis patients on the process and impact of an advance care planning intervention and to compare the perceived impacts of the intervention between African Americans and Whites.



Qualitative interviews and thematic analysis.



24 bereaved surrogates of patients from outpatient dialysis centers were interviewed. Both patients and surrogates had been participants in a larger efficacy study and had received an advance care planning intervention, SPIRIT (Sharing Patient's Illness Representations to Increase Trust).



Two themes related to the process of SPIRIT were as follows: (1) SPIRIT provided a welcome opportunity to think about and discuss topics that had been avoided and (2) SPIRIT helped patients and surrogates to share their feelings. Four themes of the SPIRIT's impact were as follows: (1) SPIRIT was an eye-opening experience, acquiring knowledge and understanding of the patient's illness and end-of-life care, (2) SPIRIT helped strengthen relationships between patients and surrogates, (3) SPIRIT helped surrogates feel prepared during the time leading up to end-of-life decision-making, and (4) SPIRIT helped surrogates have peace of mind during and after actual end-of-life decision-making. Themes related to SPIRIT's impact on feeling prepared for end-of-life decision-making and the actual decision-making experience more frequently occurred in African Americans than in Whites.



Our data may help explain the beneficial effects of SPIRIT on surrogates, but future trials should include data on control surrogates' perspectives.
1 Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
Mi-Kyung
MK
Song
2 School of Nursing, University of Virginia, Charlottesville, VA, USA.
Maureen
M
Metzger
3 School of Nursing, University of Wisconsin-Madison, Madison, WI, USA.
Sandra E
SE
Ward
D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration*; D016223:Advance Directives / Q000523:psychology*; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019727:Proxy / Q000523:psychology*; D006435:Renal Dialysis / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*; D044465:White People / Q000523:psychology*
Advance care planning; bereavement; dialysis; race; surrogate decision-maker