Life In The Slower Lane

Here is the structured PICO analysis for the thirty-third article you uploaded:

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Full Title (verbatim and exact):

“Wishes and needs of nursing home residents and their relatives regarding end-of-life decision-making and care planning—A qualitative study”

Klemmt M, Henking T, Heizmann E, et al.

Journal of Clinical Nursing (2020); 29:2663–2674

DOI: https://doi.org/10.1111/jocn.15291

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Type of Article:

Qualitative descriptive study

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PICO Analysis:

Population:

• Nursing home residents (n = 24) and their relatives (n = 8) in seven nursing homes in Würzburg, Germany
• Residents were on average 88.5 years old; most had a living will (83%) and power of attorney
• Relatives were mostly adult children (average age 56), often involved as proxies in care planning 

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Intervention (Explored Experience):

• End-of-life care planning and communication (i.e. elements of Advance Care Planning, ACP)
• Participants discussed:
  • Personal wishes and needs for end-of-life care
  • Preferred communication pathways and documentation processes
  • Trust relationships and barriers to ACP
  • Perceived roles of professionals, relatives, and themselves in decisions about future care 

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Comparator:

• No comparator group
• The study qualitatively contrasts different experiences and expectations across residents and their relatives

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Outcome:

1. Person-centred outcomes:

• Residents expressed desires for:
  • Health maintenance and pain relief
  • Minimal life-prolonging measures
  • Preservation of dignity, self-determination, and freedom
• Many expressed trust in their relatives to make end-of-life decisions, but also reluctance to initiate discussions
• Some had misunderstandings about ACP (e.g., conflating it with wills or burial plans)
• Both residents and relatives wanted greater involvement in decisions, but timing, fear, and structural barriers often prevented this 

2. Process outcomes:

• Communication patterns:
  • Residents primarily spoke with relatives, less often with staff or doctors
  • Barriers included staff time constraints, emotional discomfort, and uncertainty about whom to talk to
  • Trust and perceived competence (especially among physicians) were crucial for willingness to engage in ACP
  • Staff were seen as communication partners only if they demonstrated empathy and availability
• Documentation practices:
  • Most residents had advance directives, but their contents and storage were often unclear to facilities or relatives
  • Reasons for documentation: to reduce family burden, ensure preferences, and prevent unwanted interventions 

3. Health system outcomes:

• The study highlights systemic issues in ACP implementation:
  • Lack of structured processes for timely, competent conversations in nursing homes
  • Training needs for staff in empathetic, culturally sensitive, and legally sound ACP facilitation
  • ACP was underutilised despite high prevalence of directives, due to gaps in communication infrastructure, professional confidence, and supportive policies

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Summary Conclusion:

This qualitative study reveals that nursing home residents desire autonomy, clarity, and dignity in end-of-life planning, and prefer to discuss these matters with trusted relatives or competent professionals. While most have formal directives, there is a strong desire for ongoing, relational dialogue—especially when professionals exhibit empathy and reliability. Barriers include staff time constraints, communication fears, and limited role clarity. The study underscores the need for a targeted, culturally aware, and professionally supported ACP model that includes both relatives and trained staff under appropriate conditions.

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