[The Impact of Family-Centered Advance Care Planning for Persons With Dementia and Family Caregivers on Decision-Making Conflicts in End-of-Life Care].

BACKGROUND Participating in advance care planning (ACP) discussions during the early stages of dementia is crucial to ensuring the quality of end-of-life (EoL) care. Inadequate discussions regarding ACP and EoL care between persons with dementia and family caregivers often lead to decisional conflicts when persons with dementia are in the later stages of their disease. PURPOSE To explore the impact of a family-centered ACP information intervention on the EoL care decision-making conflicts between persons with dementia and their family caregivers. METHODS A one-group, pretest-posttest, pre-experimental design was applied. Data were collected at outpatient clinics in regional teaching hospitals in northern Taiwan. Participants included 43 dyads of persons diagnosed with mild cognitive impairment or mild dementia and their family caregivers. The intervention was implemented by an ACP-trained senior registered nurse and was guided using ACP manuals and family-centered strategies. The decisional conflict scale was the main measure used. Paired t tests were used to compare differences between pre-intervention data and 4-weeks' post-intervention data. RESULTS The ACP information intervention significantly reduced the decisional conflict score for end-of-life decision making in the participants with mild dementia (p < .001). In addition, significant declines were observed in all aspects of decision-making conflicts, including value clarification, uncertainty, and effective decision-making. The mean total conflict score of the family caregivers was also significantly reduced (p < .001), but no significant difference was found in the aspect of support. CONCLUSIONS Family-centered care strategies provide knowledge about end-of-life care for persons with dementia. These strategies also facilitate regular and continuous communication between family caregivers, persons with dementia, and medical professionals, reducing decisional conflicts in EoL care.