How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change

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dc.contributor.authorGilissen, J
dc.contributor.authorPivodic, L
dc.contributor.authorGastmans, C
dc.contributor.authorVander Stichele, R
dc.contributor.authorDeliens, L
dc.contributor.authorBreuer, E
dc.contributor.authorVan den Block, L
dc.date.accessioned2018-04-18T09:42:00Z
dc.date.available2018-04-18T09:42:00Z
dc.date.issued2018-02-14
dc.date.updated2018-04-09T15:08:05Z
dc.description.abstractBackground: Advance care planning (ACP) has been identified as particularly relevant for nursing home residents, but it remains unclear how or under what circumstances ACP works and can best be implemented in such settings. We aimed to develop a theory that outlines the hypothetical causal pathway of ACP in nursing homes, i.e. what changes are expected, by means of which processes and under what circumstances. Methods: The Theory of Change approach is a participatory method of programme design and evaluation whose underlying intention is to improve understanding of how and why a programme works. It results in a Theory of Change map that visually represents how, why and under what circumstances ACP is expected to work in nursing home settings in Belgium. Using this approach, we integrated the results of two workshops with stakeholders (n = 27) with the results of a contextual analysis and a systematic literature review. Results: We identified two long-term outcomes that ACP can achieve: to improve the correspondence between residents’ wishes and the care/treatment they receive and to make sure residents and their family feel involved in planning their future care and are confident their care will be according to their wishes. Besides willingness on the part of nursing home management to implement ACP and act accordingly, other necessary preconditions are identified and put in chronological order. These preconditions serve as precursors to, or requirements for, accomplishing successful ACP. Nine original key intervention components with specific rationales are identified at several levels (resident/family, staff or nursing home) to target the preconditions: selection of a trainer, ensuring engagement by management, training ACP reference persons, in-service education for healthcare staff, information for staff, general practitioners, residents and their family, ACP conversations and documentation, regular reflection sessions, multidisciplinary meetings, and formal monitoring. Conclusions: The Theory of Change map presented here illustrates a theory of how ACP is expected to work in order to achieve its desired long-term outcomes while highlighting organisational factors that potentially facilitate the implementation and sustainability of ACP. We provide the first comprehensive rationale of how ACP is expected to work in nursing homes, something that has been called for repeatedly.
dc.identifier.apacitationGilissen, J., Pivodic, L., Gastmans, C., Vander Stichele, R., Deliens, L., Breuer, E., & Van den Block, L. (2018). How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change. <i>BMC Geriatrics</i>, http://hdl.handle.net/11427/27805en_ZA
dc.identifier.chicagocitationGilissen, J, L Pivodic, C Gastmans, R Vander Stichele, L Deliens, E Breuer, and L Van den Block "How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change." <i>BMC Geriatrics</i> (2018) http://hdl.handle.net/11427/27805en_ZA
dc.identifier.citationBMC Geriatrics. 2018 Feb 14;18(1):47
dc.identifier.ris TY - Journal Article AU - Gilissen, J AU - Pivodic, L AU - Gastmans, C AU - Vander Stichele, R AU - Deliens, L AU - Breuer, E AU - Van den Block, L AB - Background: Advance care planning (ACP) has been identified as particularly relevant for nursing home residents, but it remains unclear how or under what circumstances ACP works and can best be implemented in such settings. We aimed to develop a theory that outlines the hypothetical causal pathway of ACP in nursing homes, i.e. what changes are expected, by means of which processes and under what circumstances. Methods: The Theory of Change approach is a participatory method of programme design and evaluation whose underlying intention is to improve understanding of how and why a programme works. It results in a Theory of Change map that visually represents how, why and under what circumstances ACP is expected to work in nursing home settings in Belgium. Using this approach, we integrated the results of two workshops with stakeholders (n = 27) with the results of a contextual analysis and a systematic literature review. Results: We identified two long-term outcomes that ACP can achieve: to improve the correspondence between residents’ wishes and the care/treatment they receive and to make sure residents and their family feel involved in planning their future care and are confident their care will be according to their wishes. Besides willingness on the part of nursing home management to implement ACP and act accordingly, other necessary preconditions are identified and put in chronological order. These preconditions serve as precursors to, or requirements for, accomplishing successful ACP. Nine original key intervention components with specific rationales are identified at several levels (resident/family, staff or nursing home) to target the preconditions: selection of a trainer, ensuring engagement by management, training ACP reference persons, in-service education for healthcare staff, information for staff, general practitioners, residents and their family, ACP conversations and documentation, regular reflection sessions, multidisciplinary meetings, and formal monitoring. Conclusions: The Theory of Change map presented here illustrates a theory of how ACP is expected to work in order to achieve its desired long-term outcomes while highlighting organisational factors that potentially facilitate the implementation and sustainability of ACP. We provide the first comprehensive rationale of how ACP is expected to work in nursing homes, something that has been called for repeatedly. DA - 2018-02-14 DB - OpenUCT DO - 10.1186/s12877-018-0723-5 DP - University of Cape Town J1 - BMC Geriatrics LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change TI - How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change UR - http://hdl.handle.net/11427/27805 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1186/s12877-018-0723-5
dc.identifier.urihttp://hdl.handle.net/11427/27805
dc.identifier.vancouvercitationGilissen J, Pivodic L, Gastmans C, Vander Stichele R, Deliens L, Breuer E, et al. How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change. BMC Geriatrics. 2018; http://hdl.handle.net/11427/27805.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.sourceBMC Geriatrics
dc.source.urihttps://bmcgeriatr.biomedcentral.com/
dc.subject.otherAdvance care planning
dc.subject.otherComplex intervention
dc.subject.otherImplementation
dc.subject.otherIntervention development
dc.subject.otherMedical Research Council framework
dc.subject.otherNursing home
dc.subject.otherTheory of change
dc.titleHow to achieve the desired outcomes of advance care planning in nursing homes: a theory of change
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
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