Abstract
BACKGROUND: Understanding the fundamentals of end-of-life communication by nursing staff as part of advance care planning with older people and their family caregivers can enhance nurse education, research, and practice in end-of-life communication. We developed a preliminary theoretical framework based on previous studies, incorporating literature and perspectives from nursing staff, older people, and family caregivers. Reflection and discussion from these groups- as well as from physicians and spiritual caregivers with whom nursing staff most often collaborate in advance care planning-should be included to ensure accuracy and enrich the framework. OBJECTIVE: To enrich and provide a multiple discipline perspective on a preliminary theoretical framework for end-of-life communication by nursing staff as part of advance care planning with older people. METHODS: Five semi-structured focus group interviews were conducted. Four focus groups were discipline-specific, and one included various disciplines. Data were analyzed using framework analysis; the five overarching themes and twenty fundamentals from the preliminary theoretical framework served as the coding structure. RESULTS: Ten nursing staff members, eight physicians, seven spiritual caregivers, and eight patient-family caregiver representatives participated. The interview results enriched the framework and understanding of end-of-life communication. Participants emphasized the importance of prioritizing mutual trust over a long-term relationship, distinguishing between feeling able and being able to talk about the end of life, not having an intended outcome for the conversation other than seeking connection, and prioritizing silence over speaking to ensure that older people and family caregivers feel seen and heard. CONCLUSION: Nursing staff, typically very proactive professionals, may need to step back, reflect, remain silent, and sit down to connect with older people and family caregivers. The revised theoretical framework can help nursing staff become aware of, learn from, prepare for, engage in, and evaluate person-centered end-of-life communication that respects the values, needs, and preferences of the older person, their family caregivers, and themselves.