Validating a theoretical framework for end-of-life communication by nursing staff as part of advance care planning with older people: An international Delphi study
Fran B.A.L. Peerboom, Jolanda H.H.M. Friesen-Storms, Jenny T. van der Steen, Daisy J.A. Janssen, Judith M.M. MeijersAbstract
Objectives
Perspectives on advance care planning (ACP) and the perceived roles of healthcare professionals in ACP can differ across cultural and national contexts. As part of a larger study, a theoretical framework of the fundamentals (important aspects) of end-of-life communication by nursing staff with older people was previously developed. We aimed to refine and achieve consensus in an international context on the theoretical framework of end-of-life communication by nursing staff as part of ACP with older people.
Methods
A 2-round online Delphi study was conducted with experts in palliative care, care for older people, end-of-life communication, and nursing. Participants evaluated the importance and clarity of the framework’s 20 fundamentals (e.g., self-efficacy, using intuition, and being silent) using a 4-point Likert scale and suggested improvements.
Results
In the first round, 48 experts from 15 countries participated, and 46 in the second. Most had nursing or research backgrounds and lived in Europe. All fundamentals were refined based on the experts’ feedback, which focused on the fundamentals’ applicability to diverse individuals and their suitability for both formal and informal conversations. Consensus with high agreement (≥90%) was reached on 17 fundamentals and consensus with agreement (≥80%) on 2. Two agreed-upon fundamentals were combined into 1.
Significance of results
This study resulted in a refined theoretical framework with broad applicability across diverse individuals and contexts. It deepens understanding of end-of-life communication, provides guidance for nursing staff, and informs education and research. Further research is needed to confirm validity beyond Europe and to inform implementation.