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To explore surrogate decision-making practices regarding end-of-life care for people with dementia in Korean long-term care hospitals from the perspective of healthcare providers.
A qualitative descriptive study.
The data were collected through individual semi-structured interviews with 24 healthcare providers (physicians, oriental medicine doctors, registered nurses and social workers) involved in dementia end-of-life care in their current long-term care hospitals in South Korea. The data were analysed using a conventional content analytic technique.
The analysis yielded three categories and nine subcategories describing surrogate decision-making practices regarding end-of-life care for people with dementia: (a) typical circumstances of end-of-life care planning, (b) expected roles of key personnel and related challenges and (c) important considerations. Participants discussed available treatment options within long-term care hospitals and the potential transfers to acute care hospitals during admission and periods of health decline. Physicians typically led such end-of-life care planning, with nurses playing a supportive role and family members making the final decisions. However, they faced challenges in performing their roles. In end-of-life care discussions, participants weighed the patients' autonomy and best interests alongside family members' interests and other external concerns such as potential lawsuits and insufficient medical resources.
Surrogate decision-making regarding end-of-life care in the context of dementia within long-term care hospitals is considerably complex and challenging for healthcare providers, requiring multifaceted institution-sensitive support.
The study findings suggest the need for targeted education and training to enhance healthcare providers' competencies in end-of-life care discussions, advance care planning and the development of policies and regulations supporting end-of-life care-related practices within long-term care hospitals.
This study was reported in accordance with the COREQ checklist.
No patient or public contribution.
To describe and compare nurses' awareness of, attitudes toward, and participation in advance care planning, as well as related facilitators and challenges, in four types of healthcare settings.
A cross-sectional descriptive study.
Four hundred and ninety-eight registered nurses from tertiary, secondary and primary healthcare institutions, along with long-term care centres in South Korea, participated in an investigator-developed online survey. The collected data were analysed using descriptive statistics, chi-squared test, one-way ANOVA, and binary logistic regression.
Participants were on average 30.6 ± 7.3 years old, mostly female (95.4%), employed as staff nurses (95.4%), held bachelor's degrees or higher (84.1%), and had worked for less than 5 years at their current institutions (69.7%). Overall, 49% of the participants were familiar with advance care planning. While most participants supported nurse involvement in advance care planning with patients and surrogates, fewer were willing to engage or recommend it. Less than half were actively engaged in advance care planning practices. A notable challenge was the lack of time due to excessive workload. Compared to those from tertiary healthcare institutions, participants from secondary and primary healthcare institutions and long-term care centres were less likely to be aware of advance care planning. Participants from secondary and primary healthcare institutions had lower odds of checking for the presence of advance directives and the physician orders for life-sustaining treatment.
Nurses demonstrated low awareness and participation in advance care planning. Nurses' insufficient time and competency to conduct advance care planning in their practice should be addressed.
Educational programs, initiatives (e.g. guidelines, position statements) and legal and policy-level efforts (e.g. nurse staffing, role clarification, reimbursement) are crucial to incorporate advance care planning into routine nursing practice.
What problem did the study address?
Nurses play an important role in advance care planning; however, limited is understood about their readiness and involvement in such practices.
What were the main findings?
Nurses' awareness of advance care planning practices and their participation in such practices is low across care settings. Although nurses have a positive attitude toward advance care planning, there are challenges (e.g. insufficient time to conduct advance care planning discussions and lack of relevant knowledge and skills) that impede their participation in practice.
Where and on whom will the research have an impact?
This study may serve as a foundation for nursing societies in countries, where advance care planning is emerging, to discuss strategies to increase nurses' competency in advance care planning and promote their participation in the practice.
The STROBE checklist was followed.
No patient or public contribution.
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