Implementation of an advance care planning intervention in nursing homes: an international multiple case study

Kevin Brazil*, Catherine Walshe, Julie Doherty, Andrew J E Harding, Nancy Preston, Laura Bavelaar, Nicola Cornally, Paola Di Giulio, Silvia Gonella, Irene Hartigan, Catherine Henderson, Sharon Kaasalainen, Martin Loucka, Tamara Sussman, Karolina Vlckova, Jenny T van der Steen, mySupport study group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


BACKGROUND AND OBJECTIVES: The inability of individuals in the advanced stage of dementia to communicate about preferences in care at the end-of-life poses a challenge for healthcare professionals and family carers. The proven effective Family Carer Decision Support intervention, has been designed to inform family carers about end-of-life care options available to a person living with advanced dementia. The objectives of the mySupport study was to adapt the application of the intervention for use in different countries, assess impact on family satisfaction and decision-making and , and identify costs and supportive conditions for the implementation of the intervention.

RESEARCH DESIGN AND METHODS: A multiple case study design was chosen where the nursing home was the case. Nursing homes were enrolled from six countries: Canada, Czech Republic, Italy, Netherlands, Republic of Ireland, United Kingdom.

RESULTS: Seventeen cases (nursing homes) participated, with a total of 296 interviews completed including family carers, nursing home staff, and health providers. Five themes relevant to the implementation of the intervention were identified: supportive relationships; committed staff; perceived value of the intervention; the influence of external factors on the nursing home; and resource impact of delivery.

DISCUSSION AND IMPLICATIONS: There is a commonality of facilitators and barriers across countries when introducing practice innovation. A key learning point was the importance of implementation being accompanied with committed and supported nursing home leadership. The nursing home context is dynamic and multiple factors influence implementation at different points of time.

Original languageEnglish
JournalThe Gerontologist
Early online date13 Feb 2024
Publication statusEarly online date - 13 Feb 2024

Bibliographical note

© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.


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