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OBJECTIVES: This study describes the perspectives of aged care staff on when and how they communicate with families to plan end-of-life care. METHODS: This qualitative descriptive study sought the perspectives of aged care staff about end-of-life care conversations with families, using interviews, focus groups and inductive thematic analysis. RESULTS: Interviews were conducted with 64 aged care staff, predominantly females, representing 14 different aged care sites. Participants included registered nurses, enrolled nurses, care managers and support workers. Five key themes were identified: (1) timing as a staged and adaptive process, (2) building expectations over time prepares families for decision-making, (3) clear communication helps manage mismatch in family perceptions of decline, (4) family dynamics and cultural context shape the communication process, and (5) confidence, role clarity and medical endorsement influence communication. CONCLUSIONS: Aged care staff are committed to engaging with families early but often face barriers when talking about end-of-life. When there is no prognosis or families are reluctant to discuss end-of-life plans, staff use various strategies to describe symptoms and changes in an older person's functions, with experienced clinical staff being more direct about deterioration. Findings highlight the need for training to build staff confidence to initiate early and ongoing communication with families. Resources for both staff and families may facilitate discussions and enhance the quality of end-of-life communication and care outcomes in aged care settings.
Vandersman et al. (Wed,) studied this question.