Certified nursing assistants’ perspectives on their role in advance care planning for older persons: A qualitative study

BACKGROUND: Advance care planning in older persons with palliative care needs is often not (timely) initiated. Certified nursing assistants are closely involved in the (daily) care for older persons and have important insights regarding their clients' care preferences and quality of life. However, their role in advance care planning is currently overlooked. AIM: To examine the perspectives of nursing assistants on their role in advance care planning for older persons. DESIGN: A qualitative descriptive study design using semi-structured interviews. SETTING/PARTICIPANTS: Fifteen nursing assistants working in community care and nursing homes in the Netherlands were interviewed between March and December 2023. A combined inductive and deductive thematic analysis was performed using the Capability, Opportunity, Motivation Behavioral model. RESULTS: Most nursing assistants were not structurally involved in advance care planning and were in need of additional knowledge and skills (capability). The team culture affected nursing assistants' opportunities and motivation to participate in advance care planning both positively and negatively. The opportunity was further shaped by nursing assistants' relationship with clients and relatives and time management, while motivation also depended on personal circumstances. CONCLUSION: This study found several barriers and facilitators affecting nursing assistants' role in advance care planning for older persons. Structurally involving nursing assistants in advance care planning, supporting their work environment, and empowering them can foster equal collaboration with other healthcare professionals. This might contribute to the timely initiation of advance care planning and palliative care for older persons.