End-of-Life Care Discussion for Residents With Dementia in Long-Term Care Facilities

10.1097/jnr.0000000000000240

Hsiu-Li HUANG；Li-Chueh WENG；Wen-Yu HU；Yea-Ing Lotus SHYU；Wen-Pin YU；Kang-Hua CHEN

long-term care facility ； dementia ； advance directives ； end-of-life care ； healthcare professionals

The Journal of Nursing Research

26卷4期（2018 / 08 / 01）

231 - 241

英文

Background: Healthcare professionals play an important role in end-of-life care decisions. Although the factors affecting end-of-life care in long-term care facilities have been well studied in Western contexts, few studies have examined factors affecting end-of-life care discussions for residents with dementia among multidisciplinary professionals in Asian or Taiwanese contexts. Purpose: The aim of this study was to explore the factors related to the end-of-life care discussions of registered nurses, social workers, and physicians with residents with dementia and their families. Methods: This is a cross-sectional and correlational study. A stratified random sampling was conducted, and self-administered questionnaires were mailed to physicians, registered nurses, and social workers who work in long-term care facilities with accreditation ranks Q Grade A in Taiwan. Results: Questionnaires were returned by 478 participants (response rate = 94.1%). Fewer than 10% of the participants reported often discussing end-of-life care with residents with dementia and their families. Physicians were significantly more likely to discuss life-sustaining treatment than nurses and social workers. The frequency of professionals discussing advance directives and life-sustaining treatment for residents with dementia was predicted by higher confidence in end-of-life care skills and greater perceived facility support. Conclusions/Implications for Practice: Most professionals did not frequently discuss end-of-life care with residents with dementia and their caregivers. Discussions of end-of-life care in long-term care facilities should be promoted by enhancing the confidence of these professionals in providing end-of-life care and creating a supportive environment for end-of-life discussions and care.

1. Ampe, S.,Sevenants, A.,Smets, T.,Declercq, A.,Van Audenhove, C.(2016).Advance care planning for nursing home residents with dementia: Policy vs. practice.Journal of Advanced Nursing,72(3),569-581.
2. Casey, D.,Murphy, K.,Ni Leime, A.,Larkin, P.,Payne, S.,Froggatt, K. A.,O'Shea, E.(2011).Dying well: Factors that influence the provision of good end-of-life care for older people in acute and long-stay care settings in Ireland.Journal of Clinical Nursing,20(13-14),1824-1833.
3. Chen, R. C.(2009).The spirit of humanism in terminal care: Taiwan experience.The Open Area Studies Journal,2,7-11.
4. Chen, T. F.,Chiu,M. J.,Tang, L. Y.,Chiu, Y. H.,Chang, S. F.,Su, C. L.,Chen, R. C.(2007).Institution type-dependent high prevalence of dementia in long-term care units.Neuroepidemiology,28(3),142-149.
5. Cheng, S. Y.,Suh, S. Y.,Morita, T.,Oyama, Y.,Chiu, T. Y.,Koh, S. J.,Tsuneto, S.(2015).A cross-cultural study on behaviors when death is approaching in East Asian countries: What are the physician-perceived common beliefs and practices?.Medicine,94(39),e1573.
6. Dening, K. H.,Jones, L.,Sampson, E. L.(2011).Advance care planning for people with dementia: A review.International Psychogeriatrics,23(10),1535-1551.
7. DeVleminck, A.,Pardon, K.,Beernaert, K.,Deschepper, R.,Houttekier, D.,Van Audenhove, C.,Vander Stichele, R.(2014).Barriers to advance care planning in cancer, heart failure and dementia patients: A focus group study on general practitioners' views and experiences.PLoS One,9(1),e84905.
8. Faul, F.,Erdfelder, E.,Buchner, A.,Lang, A. G.(2009).Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses.Behavior Research Methods,41(4),1149-1160.
9. Givens, J. L.,Jones, R. N.,Shaffer, M. L.,Kiely, D. K.,Mitchell, S. L.(2010).Survival and comfort after treatment of pneumonia in advanced dementia.Archives of Internal Medicine,170(13),1102-1107.
10. Givens, J. L.,Selby, K.,Goldfeld, K. S.,Mitchell, S. L.(2012).Hospital transfers of nursing home residents with advanced dementia.Journal of the American Geriatrics Society,60(5),905-909.
11. Gjerberg, E.,Førde, R.,Bjørndal, A.(2011).Staff and family relationships in end-of-life nursing home care.Nursing Ethics,18(1),42-53.
12. Hegde, S.,Ellajosyula, R.(2016).Capacity issues and decision making in dementia.Annals of Indian Academy of Neurology,19(1, Suppl.),S34-S39.
13. Hicks, K. L.,Rabins, P. V.,Black, B. S.(2010).Predictors of mortality in nursing home residents with advanced dementia.American Journal of Alzheimer's Disease and Other Dementias,25(5),439-445.
14. Houttekier, D.,Cohen, J.,Bilsen, J.,Addington-Hall, J.,Onwuteaka-Philipsen, B. D.,Deliens, L.(2010).Place of death of older persons with dementia. A study in five European countries.Journal of the American Geriatrics Society,58(4),751-756.
15. Huang, H. L.,Weng, L. C.,Yeh, C. M.(2011).Palliative care for persons with dementia.Journal of Nursing,58(1),91-96.
16. Lacey, D.(2005).Predictors of social service staff involvement in selected palliative care tasks in nursing homes: An exploratory model.American Journal of Hospice & Palliative Care,22(4),269-276.
17. Lithgow, S.,Jackson, G. A.,Browne, D.(2012).Estimating the prevalence of dementia: Cognitive screening in Glasgow nursing homes.International Journal of Geriatric Psychiatry,27(8),785-791.
18. Liu, L. M.,Guarino, A. J.,Lopez, R. P.(2012).Family satisfaction with care provided by nurse practitioners to nursing home residents with dementia at the end of life.Clinical Nursing Research,21(3),350-367.
19. Lo, Y.,Wang, J. J.,Liu, L. F.,Wang, C. N.(2010).Prevalence and related factors of do-not-resuscitate directives among nursing home residents in Taiwan.Journal of the American Medical Directors Association,11(6),436-442.
20. Lynch, T.,Clark, D.,Centeno, C.,Rocafort, J.,de Lima, L.,Filbet, M.,Wright M.(2010).Barriers to the development of palliative care in Western Europe.Palliative Medicine,24(8),812-819.
21. Marshall, B.,Clark, J.,Sheward, K.,Allan, S.(2011).Staff perceptions of end-of-life care in aged residential care: A New Zealand perspective.Journal of Palliative Medicine,14(6),688-695.
22. Ministry of Health and Welfare, Taiwan, ROC. (2013). The name list of general nursing home accreditation (2010-2013). Retrieved from http://www.mohw.gov.tw/MOHW_Upload/doc/100-1020042702002.pdf
23. Ministry of the Interior, Taiwan, ROC. (2012). The results of senior welfare institution accreditations 2010. Retrieved from http://webarchive.ncl.edu.tw/archive/disk19/26/23/80/56/92/201001083095/20120515/web/sowf.moi/04/19/19.htm
24. Rurup, M. L.,Onwuteaka-Philipsen, B. D.,Pasman, H. R.,Ribbe, M.W.,van der Wal, G.(2006).Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursing home patients with dementia.Patient Education and Counseling,61(3),372-380.
25. van der Steen, J. T.,Radbruch, L.,Hertogh, C. M.,de Boer, M. E.,Hughes, J. C.,Larkin, P.,European Association for Palliative Care(2014).White paper defining optimal palliative care in older people with dementia: A delphi study and recommendations from the European Association for Palliative Care.Palliative Medicine,28(3),197-209.
26. van Soest-Poortvliet, M. C.,van der Steen, J. T.,Gutschow, G.,Deliens, L.,Onwuteaka-Philipsen, B. D.,de Vet, H. C.,Hertogh, C. M.(2015).Advance care planning in nursing home patients with dementia: A qualitative interview study among family and professional caregivers.Journal of the American Medical Directors Association,16(11),979-989.
27. Vandervoort, A.,van den Block, L.,van der Steen, J. T.,Volicer, L.,Vander Stichele, R.,Houttekier, D.,Deliens, L.(2013).Nursing home residents dying with dementia in Flanders, Belgium: A nationwide postmortem study on clinical characteristics and quality of dying.Journal of the American Medical Directors Association,14(7),485-492.
28. Wu, Y. T.,Lee, H. Y.,Norton, S.,Chen, C.,Chen, H.,He, C.,Brayne, C.(2013).Prevalence studies of dementia in mainland China, Hong Kong and Taiwan: A systematic review and meta-analysis.PLoS One,8(6),e66252.

1. 劉建良,黃秀梨,呂偉如(2021)。生命自主方案對輕度認知障礙者與其家庭照顧者參與預立醫療照護諮商及末期維生醫療抉擇意向之影響。台灣公共衛生雜誌，40(6)，699-712。