Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Enhancing Partnership with Patients and Community (Projects initiated to engage patients / carers / community to improve efficiency / quality of care)
Authors (including presenting author) :
Lau SN (1), Lai BK (1), Wong NY(1), Li HY (1), Li PY (1), Tai TL (1), Ho SK(1), Pang HS(1), Kng PLC (1)
Affiliation :
(1) Department of Medicine & Geriatric, Ruttonjee Hospital
Introduction :
To respect patient’s values and ensure quality care in line with personal preferences, Advanced care planning (ACP) serves as an importance means to preserve patient’s dignity at the end of life (Lin et al., 2019). To initiate an ACP discussion, patient, families and caregivers must have a comprehensive understanding of various medical information to aid their decision making. However, older adults are often excluded from ACP discussion in view of their comparatively low health literacy (Lai & Chan, 2023). Life story book (LSB) is a tool for life review and guided discussion which promotes feeling of life completion and spiritual well-being through memory of past history and attainments (Ando et al., 2010), and facilitate ACP discussion between healthcare professionals, patients and relatives.
Objectives :
Through the development of LSB, quality care was enhanced by
- Improve health literacy of patients and their family members through the guided discussion
- Building rapport between patients and patients’ family with the health care team
- Enhance understanding of health care workers toward patient’s personal preference and decision and facilitate initiation of ACP
Methodology :
The program was piloted from June to December 2023, targeting patients admitted to geriatric rehabilitation and palliative units with life-limiting illnesses. Verbal consents were obtained from both patients and their significant others before completing all 5 chapters of the LSB. A satisfaction survey was conducted with the clients, covering a total of 6 questions and 3 main domains. Evaluation of the perspective of clients on the LSB and staff feedback were conducted after the implementation
Result & Outcome :
A total of 24 patients were recruited from the geriatrics wards, but 4 patients dropped out due to death or early discharge, thus remaining 20 patients completed the study. Within which 3 patients were acheived to develop their ACP.
According to the satisfaction survey using a 5-Point Likert Scale, both patient and relatives expressed positive sentiments and satisfaction with LSB, (μ= 4.53, range = 4-5). And the LSB was perceived as beneficial for reviewing one’s life and fostering appreciation in both groups (μ=4.47, range = 3-5). The LSB showed particularly effective in facilitating relationship-building and understanding in advance care planning and preferences.
On the other hand, nurses from both geriatrics and palliative unit found value in the life story book and believed it helped them understand the patient’s life and appreciate their uniqueness. Furthermore, it was revealed that geriatrics nurses were capable to conduct ACP discussion as good as the nurses in palliative unit.
Written feedback from both patients' relatives and nurses stated that the LSB facilitated them to express feelings and ideas to their love one, the book provided valuable psychological support when patients were experiencing advanced illness and clients appreciated the holistic care provided.
Nurses indicated that the LSB facilitated rapport building between patients, relatives, deepened their understanding of the patients, enabling them to provide more individualized care and initiate ACP effectively.
