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How to achieve the desired outcomes of advance care planning in nursing homes : a theory of change. / Gilissen, J; Pivodic, L; Gastmans, C; Vander Stichele, R; Deliens, L; Breuer, E; Van den Block, L.

In: BMC Geriatrics, Vol. 18, No. 1, 47, 14.02.2018, p. 47.

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Gilissen, J ; Pivodic, L ; Gastmans, C ; Vander Stichele, R ; Deliens, L ; Breuer, E ; Van den Block, L. / How to achieve the desired outcomes of advance care planning in nursing homes : a theory of change. In: BMC Geriatrics. 2018 ; Vol. 18, No. 1. pp. 47.

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@article{98d2f35ee61a4e68bfac2d7e091d7a4e,
title = "How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change",
abstract = "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.ONCLUSIONS: 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.",
keywords = "Advance care planning, Complex intervention, Implementation, Intervention development, Medical Research Council framework, Nursing home, Theory of change, Physicians, Humans, Documentation, Professional-Family Relations, Belgium, Advance Care Planning/organization & administration, Aged, Program Evaluation, Nursing Homes/organization & administration, Communication",
author = "J Gilissen and L Pivodic and C Gastmans and {Vander Stichele}, R and L Deliens and E Breuer and {Van den Block}, L",
year = "2018",
month = "2",
day = "14",
doi = "10.1186/s12877-018-0723-5",
language = "English",
volume = "18",
pages = "47",
journal = "BMC Geriatrics",
issn = "1471-2318",
publisher = "BioMed Central",
number = "1",

}

RIS

TY - JOUR

T1 - How to achieve the desired outcomes of advance care planning in nursing homes

T2 - BMC Geriatrics

AU - Gilissen, J

AU - Pivodic, L

AU - Gastmans, C

AU - Vander Stichele, R

AU - Deliens, L

AU - Breuer, E

AU - Van den Block, L

PY - 2018/2/14

Y1 - 2018/2/14

N2 - 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.ONCLUSIONS: 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.

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.ONCLUSIONS: 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.

KW - Advance care planning

KW - Complex intervention

KW - Implementation

KW - Intervention development

KW - Medical Research Council framework

KW - Nursing home

KW - Theory of change

KW - Physicians

KW - Humans

KW - Documentation

KW - Professional-Family Relations

KW - Belgium

KW - Advance Care Planning/organization & administration

KW - Aged

KW - Program Evaluation

KW - Nursing Homes/organization & administration

KW - Communication

UR - http://www.scopus.com/inward/record.url?scp=85042007239&partnerID=8YFLogxK

U2 - 10.1186/s12877-018-0723-5

DO - 10.1186/s12877-018-0723-5

M3 - Article

VL - 18

SP - 47

JO - BMC Geriatrics

JF - BMC Geriatrics

SN - 1471-2318

IS - 1

M1 - 47

ER -

ID: 36356539