title: Goals of Care or Goals of Trust? How Family Members Perceive Goals for Dying Nursing Home Residents.
abstract: Dementia affects more than 5 million Americans, and is a leading cause of death. Family members of nursing home (NH) residents with advanced dementia report difficulty making decisions about care toward the end of life. As part of a randomized trial testing an intervention to improve decision making, this qualitative study aimed to understand how family decision makers experienced goal-based decision making in advance of the death of their relative.
  
  
  
  This qualitative study was conducted as part of the goals of care clinical trial. Study participants (n = 16) were family decision makers in North Carolina whose relative with advanced dementia died after participating in the goals of care intervention. Semi-structured interviews were analyzed using a qualitative description approach.
  
  
  
  Family members' experience of decision making and death differed based on the presence or absence of trusting relationships with NH staff. Family members who reported trust described a positive end-of-life experience and less need for prescribed goals of care discussions. In the absence of trust, family members reported that goals of care discussions were ignored by staff or created confusion.
  
  
  
  Among family members of persons who recently died from dementia in NHs, expressions of trust in staff were strongly related to perceptions of decision making about goals of care. Although goals of care discussions may potentially promote communication to earn trust, the presence of pre-existing trust ultimately influenced the decision making and end-of-life experiences of residents and families.
authors.affiliation: 1 Partnerships in Aging Program, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Cherie
authors.initials: C
authors.lastname: Rosemond
authors.affiliation: 2 Cecil G. Sheps Center for Health Services Research, University of North Carolina , Chapel Hill, North Carolina.|3 Division of Geriatric Medicine, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
authors.affiliation: 2 Cecil G. Sheps Center for Health Services Research, University of North Carolina , Chapel Hill, North Carolina.|4 School of Social Work, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
mesh_terms: D000368:Aged; D001293:Attitude to Death; D003142:Communication; D003657:Decision Making; D003704:Dementia / Q000628:therapy*; D005190:Family / Q000523:psychology*; D005260:Female; D006040:Goals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009735:Nursing Homes; D010347:Patient Care Planning / Q000458:organization & administration / Q000592:standards*; D011368:Professional-Family Relations; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013727:Terminal Care / Q000379:methods / Q000592:standards*; D035502:Trust
keywords: advance care planning; communication; decision making; dementia; family