Assessing the impact of advance care planning in long-term care during COVID-19

Henry Siu is an assistant professor of family medicine at McMaster.

Long-term care (LTC) residents are at risk of over-treatment and poor quality end-of-life care during times of serious illness, such as a COVID-19 infection, shows new research from two studies by McMaster University and Queen’s University.

Through surveys with families of LTC residents and physicians, the research focused on what could improve communication and documentation about what a LTC resident would want when they become seriously ill. The research team conducted two separate studies at more than 30 LTC facilities.

The work was led by Henry Siu, assistant professor of family medicine at McMaster and Daren Heyland, director of the Clinical Research Evaluation Unit at Queen’s.

“Finding ways to improve goals of care conversations in LTC is particularly important during COVID-19,” said Siu, a family physician. “Addressing clinician barriers to participating in these conversations with LTC residents and their substitute decision-makers is just one vital part of high-quality care. Ensuring the voice of LTC residents are central and not lost during times of serious illness and decision-making completes this equation.”

The authors noted that when experiencing serious illness, LTC residents may need to rely on their loved ones to make decisions about their care at their end-of-life. The responses suggested that most residents think their families will know what to do, and many don’t think they need an advanced medical care plan. However, not documenting goals and wishes for care can lead to residents receiving care that they wouldn’t want.

The results also showed that clinicians initiate goals of care discussions only 10 per cent of the time. The research team recommended that the health-care system needs to encourage all clinicians to start engaging with patients and documenting advance medical care planning discussions well before or during LTC admission, so that documentation is readily available and accessible for LTC workers.

“The COVID-19 pandemic has shined a spotlight on the many problems that are experienced in long-term care, which unfortunately have existed for many years, including family visiting privileges, communication and care planning, and adequacy of basic care provided to residents,” said Heyland.

Read the paper in Canadian Geriatrics Journal here.

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