Aim: Conduct a search and analytic review of literature regarding
attributes of Advance Care Planning (ACP) and Advance Directive
in order to identify the experiences and the best care strategies
for older adults resident in nursing homes or long term institutions.
Methodology: An extensive electronic search was undertaken in
the following databases: Pubmed (via Ovid search), Cumulative
Index of Nursing and Allied Health (CINAHL, via EBHOST), psychINFO
and Cochrane. After analyzing and eliminating duplicates
and professional's point of view (19), 144 titles were considered
relevant: 28 opinion papers, 94 descriptive/qualitative studies or
predictive studies, 17 experimental and five systematic reviews.
Most of them were produced in North America and only 10 were
in French.
Results: With regard to European experiences, studies are scarce
and further research could benefit from North American evidence.
Contrary to Europe, nurses in North America play a major role
in the process of care planning. The major findings were related
to the poor efficacy of the completion of Advance Directives, even
in presence of a substantial variety of implementation strategies.
The evidence supports interventions that conceptualize ACP as a
process, with an emphasis on the ascertainment of patients' values
and beliefs and the necessity to include the family or loved
ones from the beginning of the process in order to favor the
expression and sharing of one's life perspectives and priorities in
care. The most relevant findings were associated with the conceptualization
of the ACP as a change in health behaviors which
needs an involvement in different stages to overcome a variety of
barriers.
Conclusion: Rigorous research in ACP for the older adults in
Swiss nursing homes that promote respect and dignity in this frail
population is needed. How to best achieve patients and families
goals should be the focus of nursing intervention and research in this
domain.