Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial.
BACKGROUND
In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor.


AIM
To evaluate the effectiveness of advance care planning with family carers in dementia care homes.


DESIGN
Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff.


SETTING/PARTICIPANTS
A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions.


RESULTS
The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (-10.5, 95% confidence interval: -16.4 to -4.7; p < 0.001).


CONCLUSION
Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.
['Brazil|Kevin|K|', 'Carter|Gillian|G|', 'Cardwell|Chris|C|', 'Clarke|Mike|M|', 'Hudson|Peter|P|', 'Froggatt|Katherine|K|', 'McLaughlin|Dorry|D|', 'Passmore|Peter|P|', 'Kernohan|W George|WG|']
D000293:Adolescent D000328:Adult D032722:Advance Care Planning D016223:Advance Directives D000368:Aged D000369:Aged, 80 and over D017028:Caregivers D003657:Decision Making D003704:Dementia D005190:Family D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009660:Northern Ireland D009735:Nursing Homes D010347:Patient Care Planning D006113:United Kingdom D055815:Young Adult
Advance care planning dementia randomized controlled trial family caregivers