Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments

Title

Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments

Creator

Baughman Kristin R; Ludwick PhD R N-B C C N S F A A N Ruth; Jarjoura PhD David; Kropp BS Denise; Shenoy BS Vimal

Publisher

The Gerontologist

Date

2019
2019-04

Description

Background and Objectives Lack of advance care planning (ACP) may increase hospitalizations and impact the quality of life for skilled nursing facility (SNF) residents, especially African American residents who may be less likely to receive ACP discussions. We examined the professional judgments of SNF providers to see if race of SNF residents and providers, and risk for hospitalization for residents influenced professional judgments as to when ACP was needed and feelings of responsibility for ensuring ACP discussions Research Design and Methods Nurses and social workers (n = 350) within 29 urban SNFs completed surveys and rated vignettes describing eight typical SNF residents. Linear mixed modeling was used to examine factors that impacted ratings of need for ACP and responsibility for ensuring ACP. Results Neither the race of the provider, resident, nor the interaction of the two were associated with either outcome variable. In contrast, providers rated (on a 9-point scale) residents at high risk for hospitalization as more in need of ACP (estimate = 0.86, confidence interval [CI] 0.65, 1.07) and felt more responsible for ensuring ACP (estimate = 0.60, CI 0.42, 0.78) Discussion and Implications Research on ACP is continuing to evolve and these results show the primacy of disease trajectory variables on providers' judgments about ACP. Differences between providers indicate a need for stronger policies and education. Further, research comparing rural, suburban, and urban SNFs is needed to explore possible forms of structural racism such as residential and SNF segregation.

Subject

Advance directives; African Americans; CONFIDENCE intervals; Gerontology And Geriatrics; Judgments; Nurses; Nursing; Quality of care; Quality of life; Race; Racism; Research design; Residential segregation; Rural areas; Rural education; Rural urban differences; Segregation; Social science research; Social workers; Urban education

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Rights

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Pages

338-338

Issue

2

Volume

59

Citation

Baughman Kristin R; Ludwick PhD R N-B C C N S F A A N Ruth; Jarjoura PhD David; Kropp BS Denise; Shenoy BS Vimal, “Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments,” NEOMED Bibliography Database, accessed January 21, 2021, https://neomed.omeka.net/items/show/6526.

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