Evaluating the Implementation of the Conversation Starter Kit in Long Term Care

Sharon Kaasalainen; Tamara Sussman; Maria Nicula; Jack Lawrence; Genevieve Thompson; Lynn McCleary; Abigail Wickson-Griffiths; John J You; SPA-LTC team

doi:10.1177/23779608211051824

Evaluating the Implementation of the Conversation Starter Kit in Long Term Care

SAGE Open Nurs. 2021 Nov 1:7:23779608211051824. doi: 10.1177/23779608211051824. eCollection 2021 Jan-Dec.

Authors

Sharon Kaasalainen¹, Tamara Sussman², Maria Nicula³, Jack Lawrence², Genevieve Thompson⁴, Lynn McCleary⁵, Abigail Wickson-Griffiths⁶, John J You⁷; SPA-LTC team

Affiliations

¹ School of Nursing, McMaster University, Hamilton, ON, Canada.
² Faculty of Arts, School of Social Work, McGill University, Montreal, QC, Canada.
³ Health Research Methodology, McMaster University, Hamilton, ON, Canada.
⁴ College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba,Winnipeg, MB, Canada.
⁵ Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada.
⁶ Faculty of Nursing, University of Regina, Regina, SK, Canada.
⁷ Division of General Internal and Hospitalist Medicine, Credit Valley Hospital, Mississauga, Ontario, Canada.

Abstract

Introduction: Advance care planning can improve the quality of life for residents in long-term care homes and reduce stress for families. However, care home staff and families often lack knowledge about advance care planning, making it especially difficult for residents with dementia to communicate their care plan wishes. A Conversation Starter Kit may increase advance care planning awareness among staff and families.

Objectives: This study evaluated an advance care planning intervention, the Conversation Starter Kit booklet, for use in long term care homes.

Methods: Data were collected at three long-term care homes in southern Ontario. We collected data from 55 residents who were able to make decisions on their own paired with 11 family members of these residents. We also collected data from 24 family members of residents who were unable to make decisions on their own. This study used a quasi-experimental, one group pre/post design. Quantitative surveys were administered before and after a three-month advance care planning intervention. An additional structured interview was completed at the end of the intervention period, which included both closed and open-ended questions to assess perceptions about the booklet's use or non-use.

Results: Residents reported more engagement in advance care planning after completing the Conversation Starter Kit booklet, particularly related to asking questions to health care providers about health care decisions. Family members reported feeling very certain that they would be able to make decisions on behalf of the resident but felt less certain after completing the booklet, implying the booklet raised their awareness of the types of decisions they might need to make, hopefully prompting them to be more prepared for decisions in the future.

Conclusions: An advance care planning intervention - The Conversation Starter Kit booklet - appears acceptable and easy to use for residents and family members/friends in long-term care and can improve resident engagement in advance care planning. Although using the booklet may decrease efficacy for decision making among family members of long-term care residents, it may highlight the importance of more actionable engagement in advance care planning among residents, their families/friends, and staff.

Keywords: advance care planning; dementia; end-of-life care; long-term care; palliative approach.