Experiences of Older Adults with Frailty Not Completing an Advance Directive: A Qualitative Study of ACP Conversations

Zoe Wan, Helen Y. L. Chan, Patrick K. C. Chiu, Raymond S. K. Lo, Hui-Lin Cheng and Doris Y. P. Leung
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Zoe Wan: School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China
Helen Y. L. Chan: Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong 999077, China
Patrick K. C. Chiu: Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
Raymond S. K. Lo: Department of Hospice and Palliative Medicine, Shatin Hospital and Bradbury Hospice, Hong Kong 999077, China
Hui-Lin Cheng: School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China
Doris Y. P. Leung: School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China

IJERPH, 2022, vol. 19, issue 9, 1-13

Abstract: Advance care planning (ACP) facilitates individuals to proactively make decisions on their end-of-life care when they are mentally competent. It is highly relevant to older adults with frailty because they are more vulnerable to cognitive impairment, disabilities, and death. Despite devoting effort to promoting ACP among them, ACP and advance directive completion rates remain low. This study aims to explore the experiences among frail older adults who did not complete an advance directive after an ACP conversation. We conducted a thematic analysis of audiotaped nurse-facilitated ACP conversations with frail older adults and their family members. We purposively selected ACP conversations from 22 frail older adults in the intervention group from a randomized controlled trial in Hong Kong who had ACP conversation with a nurse, but did not complete an advance directive upon completing the intervention. Three themes were identified: “Refraining from discussing end-of-life care”, “Remaining in the here and now”, and “Relinquishing responsibility over end-of-life care decision-making”. Participation in ACP conversations among frail older adults and their family members might improve if current care plans are integrated so as to increase patients’ motivation and support are provided to family members in their role as surrogate decision-makers.

Keywords: geriatrics; frailty; advance care planning; end-of-life care; qualitative research; thematic analysis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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