• Age and ageing · Mar 2019

    Randomized Controlled Trial

    Experiences with and outcomes of Advance Care Planning in bereaved relatives of frail older patients: a mixed methods study.

    • Anouk Overbeek, Ida J Korfage, Bernard J Hammes, Agnes van der Heide, and Rietjens Judith A C JAC Department of Public Health, Erasmus MC, University Medical Center Rotterdam, CA Rotterdam, The Netherlands..
    • Department of Public Health, Erasmus MC, University Medical Center Rotterdam, CA Rotterdam, The Netherlands.
    • Age Ageing. 2019 Mar 1; 48 (2): 299-306.

    BackgroundAdvance Care Planning (ACP) may prepare relatives of frail older patients for future decision-making.Objectiveto investigate (1) how bereaved relatives of frail older patients experience ACP conversations and (2) whether ACP has an effect on relatives' preparation for decision-making and on their levels of anxiety and depression.Designcluster randomised controlled trial.Settingresidential care homes in the Netherlands and community setting.Subjectsbereaved relatives of care home residents and community-dwelling frail older patients.Methodswe randomised 16 residential care homes to either the intervention group, where patient-participants were offered facilitated ACP, or the control group (n = 201), where they received 'care as usual'. If patient-participants died, we approached relatives for an interview. We asked relatives who had attended ACP conversations for their experience with ACP (open-ended questions). Furthermore, we compared relatives' preparation levels for decision-making and levels of anxiety and depression (HADS) between groups. This trial was registered (NTR4454).Resultswe conducted interviews with 39/51 (76%) bereaved relatives (intervention group: n = 20, control group: n = 19). Relatives appreciated the ACP conversations. A few considered ACP redundant since they were already aware of the patients' preferences. Nine of 10 relatives in the intervention group felt adequately prepared for decision-making as compared to 5 of 11 relatives in the control group (P = 0.03). Relatives' levels of anxiety and depression did not differ significantly between groups.Conclusionsin our study, bereaved relatives of frail older patients appreciated ACP. ACP positively affected preparedness for decision-making. It did not significantly affect levels of anxiety or depression.© The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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