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Background: The proportion of hospital deaths has declined in the past few decades, while the proportions of nursing home deaths have increased. This trend of increasing deaths in long-term care facilities underlines the importance of improving end-of-life care provisions in these settings to meet individual preferences and needs. Under these circumstances, a comprehensive understanding of end-of-life care preferences in local nursing home residents can help healthcare professionals and policymakers develop strategies to increase the advance directive completion rate and quality of care. This study aimed to explore and compare advance directive and end-of-life care preferences of nursing home residents in Hong Kong and Taiwan. Methods: A structured questionnaire was developed by the research team to investigate advance directive and end-of-life care preferences in older Chinese nursing home residents. Nursing home residents with frail or pre-frail status and over the age of 64 were invited to participate in the study, and information on demographics, functional status, advance directive experiences, and end-of-life care expectations was collected through questionnaire interviews. Results: A total of 325 eligible participants from 32 facilities completed the survey, including 238 older residents in Hong Kong and 87 in Taiwan. A significantly lower proportion of the Hong Kong residents had completed an advance directive compared with the Taiwanese (3 vs. 13%, p = 0.001). Among participants who did not have an advance directive, 46% of the Taiwanese participants said they would consider completing one in the future, compared with 20% of the Hong Kong participants (p < 0.001). A total of 79% of the Hong Kong participants and 80% of the Taiwanese participants responded that prolonging life in the given hypothetical dying scenario was "not important" (p = 0.76). Only 14% of participants in Hong Kong and 18% of participants in Taiwan reported prior occurrence of end-of-life care discussions with family members or health professionals (p = 0.37). Conclusions: This paper adds evidence in support of improving end-of-life communication and the advance directive completion rate in nursing homes in Hong Kong and Taiwan. Further research is necessary to explore cross-cultural differences in end-of-life preferences and its applications in predicting decision-making and the quality of end-of-life care. [ABSTRACT FROM AUTHOR]

Background: Training has been found effective in improving healthcare professionals' knowledge, confidence, and skills in conducting advance care planning (ACP). However, the association between training and its actual practice in the clinical setting has not been well demonstrated. To fill this gap, this paper examines the association between their readiness for ACP, in terms of perceived relevancy of ACP with their clinical work, attitudes toward and confidence and willingness to perform it, based on the Theory Planned Behavior and relevant training experiences. Methods: An online survey about experiences about ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted. Results: Of 250 respondents, approximately half (52.0%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and different levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001–0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience. Conclusions: This paper revealed the association between training and higher level of readiness toward ACP among healthcare professionals. The findings showed that training is a predictor of their readiness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation. [ABSTRACT FROM AUTHOR]

Background. Older adults in residential care homes in Hong Kong usually have multiple co-morbidities and need end-of-life (EOL) care. Repeated hospitalisations before death are common. The Hospital Admission Risk Reduction Program for the Elderly (HARRPE) score is correlated with mortality. We compared older adults identified by clinical referral with older adults identified by HARRPE score ≥0.4 in terms of EOL programme enrolment rate and mortality rates at 180 and 365 days. Methods. This retrospective cohort study included older adults aged ≥80 years residing in care homes from 1 July 2018 to 30 June 2019. We compared older adults identified by clinical referral with older adults identified by HARRPE score ≥0.4 in terms of EOL programme enrolment rate and mortality rates at 180 and 365 days. Results. Of 113 clinical referral patients and 735 patients with HARRPE score ≥0.4, 102 and 96, respectively, fulfilled EOL programme criteria. Their mean age was 92 years, with female predominance (71%). Enrolment rates were similar (57% and 51%, respectively). Survival probability was higher among enrolled patients than among nonenrolled patients (p<0.001). The two groups were comparable in terms of the 180-day mortality rate and 365-day mortality rate. In both groups, survival probabilities were higher in patients who enrolled in the EOL programme, compared with patients who did not enrol (p<0.001). The median survival was longer in the HARRPE group (191 vs 155 days). Conclusions. Older adults in residential care homes requiring EOL care according to HARRPE score ≥0.4 have similar enrolment and mortality rates, compared with clinical referral. The HARRPE score is a feasible tool to supplement clinical referral for timely EOL care. [ABSTRACT FROM AUTHOR]

This study aimed to examine the effects of an advance care planning (ACP) group which was developed by social workers in Hong Kong for older adults. A quasi‐experimental study was conducted. Participants were recruited from 14 residential care homes. The ACP intervention group included 59 participants for analyses, and the control group 58. Three major outcomes were measured at two time points: (a) Quality‐of‐life concerns, (b) End‐of‐life preference and (c) Advance directive (AD)‐related outcomes (awareness of AD, AD completion, willingness to complete AD and communication with family members about AD). Findings indicate that the ACP group enhanced participants' awareness of AD compared with the control group. Participants were also more willing to complete AD, and more participants communicated with family members about AD after participating in the ACP group. No significant difference was found in other outcomes. This study demonstrates the efforts of social workers in promoting ACP in Hong Kong and the effectiveness of an ACP group for enhancing older adults' awareness of AD. Findings support the role of social workers in promoting ACP for deprived groups, like frail older adults. The ACP group could be considered a first step in enhancing older adults' awareness of and willingness to discuss end‐of‐life issues. Further follow‐up is required to develop individualised ACP for older adults. [ABSTRACT FROM AUTHOR]

Aims and objectives To report on the effectiveness of an eight-week palliative care programme in Hong Kong. Background A recent survey reported that the quality of palliative care services in Hong Kong ranked the 20th among 40 countries and it is far behind other Asian countries. There are disagreement and inadequate communication in clinical decision-making among patients, families and healthcare professionals, and that the nurses lack sufficient knowledge and skills in providing palliative care and advance care planning. Design A pretest post-test design and semi-structured interviews were adopted. Methods A total of 108 home care patients with life-limiting disease and their family caregivers in Hong Kong were recruited to complete a set of questionnaire including The Mc Gill Quality of Life Questionnaire for Hong Kong Chinese and the Family Satisfaction Scale before and after they attended an eight-week programme. The programme comprised the elements of symptom management, intensive communication on advance care planning and psychosocial intervention. Results Pearson's chi-square tests and Wilcoxon matched paired tests show a general trend that the patients' quality of life was improved after the programme. Their understanding and active participation in advance care planning was also improved. The hospital readmission rate and the days of hospital stays were significantly reduced. In qualitative interview, four major themes were identified that are as follows: improvement in the communication of treatment plans and after-death arrangements, symptom management, emotional support and suggested areas of improvement. Conclusion The study supports the benefit of implementing a palliative care programme to patients with life-limiting disease. Patients demonstrated improved understanding and changed behaviour as regards the preparation for death and dying after the eight-week programme. Relevance to clinical practice The programme could be replicated in other hospitals and infirmaries that offer home care services. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study attempted to test the plausibility of engaging frail nursing home residents in advance care planning (ACP). Background. Advance care planning fosters communication among individuals, family and health professionals regarding end-of-life care. Yet, such practice seldom takes place in a timely fashion because of its sensitive nature; thus, the concerns of these residents are often left unattended. Design. This was a one-year quasi-experimental study to test the feasibility of the Let Me Talk ACP programme, with its design being inspired by literature and our earlier work, among frail nursing home residents. Method. Three assessments were conducted at six-month intervals to monitor the programme effects. The storytelling approach, which allowed participants to thread together their past, present and future, was the key feature of the programme. Results. Findings showed that the treatment preference stability was significantly higher in the intervention group (κ = 0·53, p ≤ 0·001). Significantly more participants in this group also communicated their treatment preferences to their family or caregivers ( p = 0·012), with an odds ratio of 4·52. The programme also had a positive effect on mitigating participants' existential distress. Conclusions. The programme was found effective in clarifying participants' treatment preferences and encouraging them to communicate their preferences to significant others. However, it was also found that involving participants' family in open discussion remained difficult. Extensive promotion in the community is therefore necessary. Relevance to clinical practice. It is recommended that such ACP programmes should be integrated into nursing home care practice, as they can be initiated in a relaxed atmosphere and maintained as an ongoing process. The trusting relationship between the nurse in the homes and the residents enables in-depth discussion. The nurse is also well placed to play the facilitator role in guiding the process, providing information and mediating the family discussion. [ABSTRACT FROM AUTHOR]