Navigating Barriers and Enablers to Advance Care Planning for Residents Living With Alzheimer's Disease and Related Dementias Nursing Homes: Strategies for Effective Implementation of the Goals of Care Video a Content Analysis.

BACKGROUND

Providing high-quality advance care planning conversations for nursing home residents living with Alzheimer's Disease and Related Dementias is a persistent challenge, but implementation of advance care planning interventions remains limited.

OBJECTIVE

This study explored barriers and enablers to implementing the Goals of Care video with nursing home staff and identified strategies to implement the video intervention.

METHODS

Nursing home administrators identified staff members involved in ACP discussions with residents and families. A research team member contacted these individuals by email or telephone. Fourteen staff members across six Florida nursing homes participated in in-person or virtual semi-structured interviews. A summative content analysis quantified the frequency of each CFIR construct coded as an enabler or barrier, with frequencies calculated at the nursing home level.

RESULTS

The primary enabler was the alignment of the Goals of Care video with nursing homes' organizational mission. The most identified barrier was the video's perceived length. Strategies to improve implementation included adapting materials, assessing readiness, and addressing site-specific challenges.

CONCLUSIONS

Tailoring the Goals of Care video to the organizational context is essential. Addressing barriers, such as video concerns, while leveraging existing enablers can strengthen adoption and support more consistent advance care planning practices.