A confluence of cultures: advance care planning in long-term care settings

Context: While policies may promote Advance Care Planning (ACP) discussions in long-term care (LTC) settings, practices often result in outcomes different from residents’ wishes. We attribute this to a confluence of cultures: healthcare; LTC settings; mainstream societal; and individuals’ ethno-cultures. This research explores these cultures as reflected in focus group discussions conducted with residents and family-of-residents in two LTC homes: one exclusively Chinese (EC); one multicultural (MC). Method: Fourteen residents and 13 family members participated in the four focus groups. Discussions were audio-recorded, transcribed, and themes were extracted and compared. Results: Four themes characterized residents’ discussions: 1-Variations in Range/Type of ACP Discussions/Actions; 2-Care of Family; 3-Reliance on Staff; and 4-Quality-of-Life at End-of-Life. Exclusively Chinese residents expressed reluctance to speak about ACP, were more likely to state “family would handle it,” less likely to call upon staff, and more acquiescent concerning death. Multicultural residents were more likely to pejoratively mention pull or absence of family and reliance upon staff; also, wanting personal awareness and control at end-of-life. Family themes were 1-Timing/Focus of ACP Discussions, 2-Communication with Family, 3-Care Home and Staff Influences, and 4-Cultural and Religious Issues. Exclusively Chinese families spoke of need to involve family in ACP discussions inclusive of residents and of Chinese cultural influences on ACP. Multicultural families reported being “taken by surprise” and feeling “overwhelmed” by requests to engage in ACP and document completion on behalf of residents. Conclusion: Findings provide evidence of multiple cultural influences on ACP in LTC but existing institutional policies and practices offer little direction and support on how to balance/prioritize them. Our analyses may provide a starting point

Web-Based Peer Navigation for Men with Prostate Cancer and Their Family Caregivers: A Pilot Feasibility Study

This study assessed the feasibility, acceptability and potential effects of True North Peer Navigation (PN)—a web-based peer navigation program for men with prostate cancer (PC) and their family caregivers. A one-arm, pre-post pilot feasibility study was conducted at two cancer centres in Canada. Participants were matched through a web-app with a specially trained peer navigator who assessed needs and barriers to care, provided support and encouraged a proactive approach to health for 3 months. Descriptive statistics were calculated, along with paired t-tests. True North PN was feasible, with 57.9% (84/145) recruitment, 84.5% (71/84) pre-questionnaire, 77.5% (55/71) app registration, 92.7% (51/55) match and 66.7% (34/51) post-questionnaire completion rates. Mean satisfaction with Peer Navigators was 8.4/10 (SD 2.15), mean program satisfaction was 6.8/10 (SD 2.9) and mean app usability was 60/100 (SD 14.8). At 3 months, mean ± SE patient/caregiver activation had improved by 11.5 ± 3.4 points (p = 0.002), patient quality of life by 1.1 ± 0.2 points (p < 0.0001), informational support by 0.4 ± 0.17 points (p = 0.03), practical support by 0.5 ± 0.25 points (p = 0.04) and less need for support related to fear of recurrence among patients by 0.4 ± 19 points (p = 0.03). The True North web-based peer navigation program is highly feasible and acceptable among PC patients and caregivers, and the associated improvements in patient and caregiver activation are promising. A randomized controlled trial is warranted to determine effectiveness.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacultyResearche