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Advance care planning and dying in nursing homes in Flanders, Belgium: a nationwide survey
De Gendt C, Bilsen J, Stichele RV, Deliens L.. Journal of pain and symptom management, 2012-08-20
Topic: Risk, prevention and care in population studies
Context In Belgium, data on actual advance care planning (ACP) in nursing homes (NHs) are scarce. Objectives To investigate the prevalence and characteristics of documented advance directives and physicians' orders for end-of-life care in NHs, and the authorization of a legal representative in relation to the residents' demographic and clinical characteristics and care received. Methods This was a retrospective cross-sectional study, including all NH residents deceased during September and October 2006 in all 594 NHs in Flanders, Belgium. Structured mail questionnaires about the resident's characteristics, hospital transfers, palliative care delivery, ACPs, and authorization of legal representatives were completed via the NH administrators and nurses involved in the care of the resident. Results Administrators of 318 NHs (53.5%) reported 1303 deaths. Nurses provided information about 1240 (95.2%) of these deaths. At the end of life, NH residents often had dementia (65.2%) and were severely dependent (76.1%). Almost half (43.1%) had at least one hospital transfer during the last three months of life and two-thirds received palliative care. Half had an ACP, predominantly a physician's order and less often an advance directive. Having advance directives or physician's orders was associated with receiving palliative care. Residents with a physician's order more often died in the NH. Nine percent had an authorized legal representative. Conclusion Prevalence of ACPs and formal authorization of a legal representative was low among the deceased NH residents in Flanders, Belgium. There was a higher prevalence of physicians' orders, often established after the resident had lost capacity. Initiatives should be developed to stimulate more advance discussion on care options and making end-of-life decision with the residents while they retain capacity.
Key findings
- Results Administrators of 318 NHs (53.5%) reported 1303 deaths.
- Having advance directives or physician's orders was associated with receiving palliative care.
Study details
- Study designcross-sectional
- Effect size53.5%; 95.2%; 65.2%
- Evidence strengthLow
How this study scored 47/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for sample size, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 27 of the 58 points we could judge it on, which is 47 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of pain and symptom management) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2013 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 22917717) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 27 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 27 of the 58 points we could judge it on is 47 out of 100. |
| Total | 47 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
De Gendt, C., Bilsen, J., Stichele, R. V., & Deliens, L. (2013). Advance care planning and dying in nursing homes in Flanders, Belgium: a nationwide survey. Journal of pain and symptom management. https://doi.org/10.1016/j.jpainsymman.2012.02.011
Vancouver
De Gendt C, Bilsen J, Stichele RV, Deliens L. Advance care planning and dying in nursing homes in Flanders, Belgium: a nationwide survey. Journal of pain and symptom management. 2013. doi:10.1016/j.jpainsymman.2012.02.011. PMID: 22917717.
BibTeX
@article{degendt2013-22917717,
author = {De Gendt, C. and Bilsen, J. and Stichele, R. V. and Deliens, L.},
title = {{Advance care planning and dying in nursing homes in Flanders, Belgium: a nationwide survey}},
journal = {Journal of pain and symptom management},
year = {2013},
doi = {10.1016/j.jpainsymman.2012.02.011},
pmid = {22917717},
url = {https://doi.org/10.1016/j.jpainsymman.2012.02.011}
}
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