title: Preconditions for successful advance care planning in nursing homes: A systematic review.
abstract: OBJECTIVE
  There is growing evidence of the potential effectiveness of advance care planning. Yet important knowledge gaps remain regarding the preconditions for successful implementation of advance care planning in the nursing home setting. We aim to identify the preconditions related to successful advance care planning in the nursing home setting. By specifying those, we would be able to make well-founded choices for the future design and planning of advance care planning intervention programs.
  
  
  METHODS
  A systematic review.
  
  
  METHODS
  PubMed, PsycINFO, EMBASE and CINAHL.
  
  
  METHODS
  Two authors independently screened publications. One author assessed methodological quality and extracted textual data, which was double-checked for a random sample. We extracted textual data and used thematic synthesis to identify "preconditions", defined as requirements, conditions and elements necessary to achieve the desired outcome of advance care planning, i.e. attaining concordance between residents' preferences and actual care or treatment received at the end of life.
  
  
  RESULTS
  Based on 38 publications, we identified 17 preconditions at five different levels: resident, family, health-care professional, facility and community. Most preconditions were situated on multiple levels but the majority addressed professionals and the nursing home itself. We summarized preconditions in five domains: to have sufficient knowledge and skills, to be willing and able to participate in advance care planning, to have good relationships, to have an administrative system in place, and contextual factors supporting advance care planning within the nursing home.
  
  
  CONCLUSIONS
  There are multiple preconditions related to successfully implementing advance care planning in the complex nursing home setting that operate at micro, meso and macro level. Future interventions need to address these multiple domains and levels in a whole-system approach in order to be better implementable and more sustainable, while simultaneously target the important role of the health-care professional and the facility itself.
authors.affiliation: End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium. Electronic address: joni.gilissen@vub.ac.be.
authors.forename: Joni
authors.initials: J
authors.lastname: Gilissen
authors.affiliation: End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium. Electronic address: lara.pivodic@vub.ac.be.
authors.forename: Lara
authors.initials: L
authors.lastname: Pivodic
authors.affiliation: End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
authors.forename: Tinne
authors.initials: T
authors.lastname: Smets
authors.affiliation: Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Box 7001, 3000 Leuven, Belgium.
authors.forename: Chris
authors.initials: C
authors.lastname: Gastmans
authors.affiliation: Department of Pharmacology, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Vander Stichele
authors.affiliation: End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Medical Oncology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium.
authors.forename: Lieve
authors.initials: L
authors.lastname: Van den Block
mesh_terms: D032722:Advance Care Planning; D009735:Nursing Homes / Q000458:organization & administration*
keywords: Advance care planning; Elderly care; Long-Term care; Nursing home; Systematic review; Theory of change