An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting.
To describe processes and preliminary outcomes from the implementation of a systematic advance care planning (ACP) intervention in the nursing home setting.



Specially trained project nurses were embedded in 19 nursing homes and engaged in ACP as part of larger demonstration project to reduce potentially avoidable hospitalizations.



Nursing homes.



Residents enrolled in the demonstration project for a minimum of 30 days between August 2013 and December 2014 (n = 2,709) and residents currently enrolled in March 2015 (n = 1,591).



ACP conversations were conducted with residents, families, and the legal representatives of incapacitated residents using a structured ACP interview guide with the goal of offering ACP to all residents. Project nurses reviewed their roster of currently enrolled residents in March 2015 to capture barriers to engaging in ACP.



During the initial implementation phase, 27% (731/2,709) of residents had participated in one or more ACP conversations with a project nurse, resulting in a change in documented treatment preferences for 69% (504/731). The most common change (87%) was the generation of a Physician Orders for Scope of Treatment form. The most frequently reported barrier to ACP was lack of time.



The time- and resource-intensive nature of robust ACP must be anticipated when systematically implementing ACP in the nursing home setting. The fact that these conversations resulted in changes over 2/3 of the time reinforces the importance of deliberate, systematic ACP to ensure that current treatment preferences are known and documented so that these preferences can be honored.
School of Nursing, Indiana University, Indianapolis, Indiana.|Research in Palliative and End-of-Life Communication and Training Signature Center, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
Susan E
SE
Hickman
Research in Palliative and End-of-Life Communication and Training Signature Center, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.|School of Medicine, Indiana University, Indianapolis, Indiana.|Regenstrief Institute, Indianapolis, Indiana.
Kathleen T
KT
Unroe
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
Mary T
MT
Ersek
Regenstrief Institute, Indianapolis, Indiana.
Bryce
B
Buente
School of Medicine, Indiana University, Indianapolis, Indiana.|Regenstrief Institute, Indianapolis, Indiana.
Arif
A
Nazir
Research in Palliative and End-of-Life Communication and Training Signature Center, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.|School of Medicine, Indiana University, Indianapolis, Indiana.|Regenstrief Institute, Indianapolis, Indiana.
Greg A
GA
Sachs
D032722:Advance Care Planning; D000368:Aged; D005260:Female; D006801:Humans; D007196:Indiana; D007407:Interviews as Topic; D008297:Male; D009723:Nurse-Patient Relations; D009735:Nursing Homes
advance care planning; decision-making; end-of-Life care; nursing home; palliative care