Nursing Homes Often Mum on End-of-Life Care

Despite growing attention to advance care planning, a recent study found that few patients in nursing homes have discussed end-of-life care with staff or their next-of-kin. Researchers published their findings, based on interviews with 35 patients at 6 Norwegian nursing homes and 33 of their next-of-kin relatives, in BMC Geriatrics.

“The interviews demonstrated that although some patients were positive about talking about these issues, others did not find it necessary or were more reluctant,” wrote the authors, led by Elisabeth Gjerberg (Center for Medical Ethics, University of Oslo, Norway). “Some of these were convinced that the staff already knew their preferences and would therefore act in their best interest, whereas others signaled quite the opposite; ie, they doubted that the staff knew them.”

Most relatives, too, said the subject had never come up, although they would welcome such conversations. Both patients and their relatives said that they wanted nursing home staff to initiate and help guide end-of-life care discussions.

“Conversations about end-of-life care issues are emotionally challenging, and very few patients had discussed these questions with their family,” researchers explained. “The relatives’ opinions of the patient’s preferences were mainly based on assumptions; they had seldom talked about this explicitly.”

The timing of conversations was important to relatives, with most saying they would not want to talk about end-of-life care in connection with or shortly after a loved one’s admittance to a nursing home. They worried that the subject, in addition to the move, would be too much of a strain for them and their loved one, preferring instead that staff be sensitive and wait for “the right time” to broach the subject. Researchers noted, however, that the best timing for end-of-life conversations is not clear.

“The staff has to be sensitive to the patients’ and relatives’ receptiveness or reluctance to discuss these topics, thereby indicating that the communication skills of health professionals are a crucial factor. A component of such highly skilled communication is to know when not to proceed with the discussion, and how to spread information over time. Caution in discussions is obviously needed,” they wrote (https://www.biomedcentral.com/1471-2318/15/103).

Not all patients considered end-of-like care discussions important, researchers reported, either because they found it difficult to predict future experiences of illness or they just wanted to leave the topic “in peace.” Noting that patients’ willingness to address the subject may change over time, researchers advised that staff respect the wishes of patients reluctant to talk on the subject but, at a later stage, offer again to discuss the issue.—Jolynn Tumolo