Research focus

Health care professionals’ perspectives of advance care planning for people with dementia living in long-term care settings: a narrative review of the literature

This comprehensive synthesis of published literature from a team in Northern Ireland focused on the perspectives of healthcare professionals in relation to ACP for people with dementia living in long-term care settings. From the 14 papers discussed, the authors identified that people with dementia are often not recognised as having a terminal illness. Four key themes were identified: ■Early integration and planning for palliative care in dementia is important. ■Healthcare professionals’ perspectives on ACP are influenced by ethical and moral concerns including presumptions regarding capacity of the person with dementia towards ACP and the impact of the increased role of the family in the decision-making processes. ■Challenges in communicating with people who have dementia and their families. ■A need for improvement in healthcare professionals’ knowledge of the disease trajectory of dementia with emphasis on end of life care, and a greater understanding of the process of ACP itself. This would assist them in engaging in ACP discussions.

The review concludes that despite evidence that they recognise potential benefits of ACP, healthcare staff struggle with its implementation in this setting. The authors say greater understanding of dementia and the concept of ACP is required to improve consistency in practice. In addition, integration between gerontology and palliative care and synthesising the existing evidence will allow for further understanding of the key issues, potentially resulting in improved implementation in practice.