Abstract：
OBJECTIVE: To explore the views and preferences for advance care planning from the perspectives of residents, family members and healthcare professionals in long-term care facilities.
METHODS: A qualitative descriptive design.
METHODS: We conducted semi-structured interviews with 12 residents of long-term care facilities, 10 family members and 14 healthcare professionals. Data were analysed using reflexive thematic analysis. The social ecological model was used to develop implementation recommendations.
RESULTS: We constructed a conceptual model of barriers and facilitators to advance care planning in long-term care facilities, drawing upon four dominant themes from the qualitative analysis: (1) The absence of discourse on end-of-life care: a lack of cultural climate to talk about death, the unspoken agreement to avoid conversations about death, and poor awareness of palliative care may hinder advance care planning initiation; (2) Relational decision-making process is a dual factor affecting advance care planning engagement; (3) Low trust and \'unsafe\' cultures: a lack of honest information sharing, risks of violating social expectations and damaging social relationships, and risks of legal consequences may hinder willingness to engage in advance care planning; (4) Meeting and respecting residents\' psychosocial needs: these can be addressed by readiness assessment, initiating advance care planning in an informal and equal manner and involving social workers.
CONCLUSIONS: Our findings show that residents\' voices were not being heard. It is necessary to identify residents\' spontaneous conversation triggers, articulate the value of advance care planning in light of the family\'s values and preferences, and respect residents\' psychosocial needs to promote advance care planning in long-term care facilities. Advance care planning may alleviate the decision-making burden of offspring in nuclear families.
CONCLUSIONS: The evidence-based recommendations in this study will inform the implementation of context-specific advance care planning in Asia-Pacific regions.
UNASSIGNED: Patients and caregivers contributed to the interview pilot and data collection.
METHODS: A qualitative descriptive design.
METHODS: We conducted semi-structured interviews with 12 residents of long-term care facilities, 10 family members and 14 healthcare professionals. Data were analysed using reflexive thematic analysis. The social ecological model was used to develop implementation recommendations.
RESULTS: We constructed a conceptual model of barriers and facilitators to advance care planning in long-term care facilities, drawing upon four dominant themes from the qualitative analysis: (1) The absence of discourse on end-of-life care: a lack of cultural climate to talk about death, the unspoken agreement to avoid conversations about death, and poor awareness of palliative care may hinder advance care planning initiation; (2) Relational decision-making process is a dual factor affecting advance care planning engagement; (3) Low trust and \'unsafe\' cultures: a lack of honest information sharing, risks of violating social expectations and damaging social relationships, and risks of legal consequences may hinder willingness to engage in advance care planning; (4) Meeting and respecting residents\' psychosocial needs: these can be addressed by readiness assessment, initiating advance care planning in an informal and equal manner and involving social workers.
CONCLUSIONS: Our findings show that residents\' voices were not being heard. It is necessary to identify residents\' spontaneous conversation triggers, articulate the value of advance care planning in light of the family\'s values and preferences, and respect residents\' psychosocial needs to promote advance care planning in long-term care facilities. Advance care planning may alleviate the decision-making burden of offspring in nuclear families.
CONCLUSIONS: The evidence-based recommendations in this study will inform the implementation of context-specific advance care planning in Asia-Pacific regions.
UNASSIGNED: Patients and caregivers contributed to the interview pilot and data collection.
摘要：
目的：从居民的角度探讨预先护理计划的观点和偏好，长期护理机构的家庭成员和医疗保健专业人员。
方法：定性描述性设计。
方法：我们对12名长期护理机构的居民进行了半结构化访谈，10名家庭成员和14名医疗保健专业人员。使用反身性主题分析对数据进行了分析。社会生态模型用于制定实施建议。
结果：我们构建了一个障碍和促进者的概念模型，以推进长期护理机构的护理计划，从定性分析中汲取四个主要主题：（1）缺乏关于临终关怀的论述：缺乏谈论死亡的文化氛围，避免谈论死亡的潜移默化的协议，对姑息治疗的意识差可能会阻碍提前护理计划的启动；（2）关系决策过程是影响提前护理计划参与的双重因素；（3）低信任和“不安全”文化：缺乏诚实的信息共享，违反社会期望和破坏社会关系的风险，法律后果的风险可能会阻碍参与预先护理计划的意愿；（4）满足和尊重居民的社会心理需求：这些可以通过准备评估来解决，以非正式和平等的方式启动预先护理计划，并让社会工作者参与。
结论：我们的研究结果表明，居民的声音没有被听到。有必要识别居民自发的对话触发因素，根据家庭的价值观和偏好，阐明提前护理计划的价值，并尊重居民的社会心理需求，以促进长期护理设施中的提前护理计划。提前护理计划可以减轻核心家庭后代的决策负担。
结论：本研究中基于证据的建议将为亚太地区实施特定背景的提前护理计划提供信息。
■患者和护理人员为访谈试点和数据收集做出了贡献。
方法：定性描述性设计。
方法：我们对12名长期护理机构的居民进行了半结构化访谈，10名家庭成员和14名医疗保健专业人员。使用反身性主题分析对数据进行了分析。社会生态模型用于制定实施建议。
结果：我们构建了一个障碍和促进者的概念模型，以推进长期护理机构的护理计划，从定性分析中汲取四个主要主题：（1）缺乏关于临终关怀的论述：缺乏谈论死亡的文化氛围，避免谈论死亡的潜移默化的协议，对姑息治疗的意识差可能会阻碍提前护理计划的启动；（2）关系决策过程是影响提前护理计划参与的双重因素；（3）低信任和“不安全”文化：缺乏诚实的信息共享，违反社会期望和破坏社会关系的风险，法律后果的风险可能会阻碍参与预先护理计划的意愿；（4）满足和尊重居民的社会心理需求：这些可以通过准备评估来解决，以非正式和平等的方式启动预先护理计划，并让社会工作者参与。
结论：我们的研究结果表明，居民的声音没有被听到。有必要识别居民自发的对话触发因素，根据家庭的价值观和偏好，阐明提前护理计划的价值，并尊重居民的社会心理需求，以促进长期护理设施中的提前护理计划。提前护理计划可以减轻核心家庭后代的决策负担。
结论：本研究中基于证据的建议将为亚太地区实施特定背景的提前护理计划提供信息。
■患者和护理人员为访谈试点和数据收集做出了贡献。
