BMC Palliative Care
Feasibility and acceptability of including advance care planning in a home-based palliative-care coordination meeting: a longitudinal ethnographic study of the experiences of older patients, their relatives and healthcare professionals
By Line Elida Festvåg, Grethe Eilertsen, Beate Lie Sverre and 1 others.
Abstract
Abstract Background Advance care planning provides a structured approach to conversations about values and preferences but is uncommon in clinical practice. We implemented advance care planning as routine at the initiation of an individually tailored palliative care pathway in Norway. An advance care planning conversation formed part of the initial care coordination meeting when palliative care was introduced to older patients with advanced cancer. Healthcare professionals met with the patient and their relatives at home. This study aimed to assess the feasibility and acceptability of including advance care planning with older patients in a home-based palliative-care coordination meeting. Methods We conducted a longitudinal ethnographic study utilizing ethnographic interviews with patients and their relatives within 1 week and 4 weeks after the initial meeting, and with healthcare professionals immediately before and after this meeting. Data were analysed using content analysis. Results All patients perceived the advance care planning conversation as useful. Proper preparation and information were prerequisites for successful outcomes. The presence of relatives, the home-based setting and healthcare professionals’ communication skills provided a comfortable atmosphere. Open discussions about sensitive topics were enabled, and the dialogue continued to evolve within the families after the conversation. However, the patients and their relatives perceived the follow-up and documentation as insufficient. Conclusion Embedding advance care planning in a home-based palliative-care coordination meeting may offer a feasible model of its implementation for older patients with advanced cancer. The conversation was well accepted, but preparation and systematic follow-up were crucial for ensuring high quality.