Necessary discussions: Advance care planning for nursing homes in a COVID-19 outbreak

It is likely that nursing homes in the UK will become clusters in their communities for the worst clinical manifestations of COVID-19 (1). Since all nursing home residents are at substantial risk, nursing home care staff need to know what residents would want to happen should they become infected with COVID-19. The aim of this project is to develop and evaluate an online advance care planning (ACP) COVID-centric intervention for nursing homes during a COVID-19 outbreak to improve care at the end of life. Findings from a rapid review of available resources will be used to develop an online ACP COVID-centric intervention for training nursing home staff and providing an information resource to family carers. To evaluate the intervention, we will conduct a prospective case study design where a nursing home will be the unit of analysis or 'case'. Nine nursing homes will participate in the project with three nursing homes located in Northern Ireland, England, and Scotland. We will collect data from up to 54 family carers and 45 nursing home staff. Expected outcomes: (a) enhanced knowledge of conducting end of life discussions during COVID distancing measures; (b) improved ability for staff to assess resident needs and respond more appropriately in relation to ACP; (c) enhanced decision making among family members regarding resident care; (d) improved communication between staff and family carers regarding their relatives health care needs; (e) increased evidence of completed ACPs; (f) development of open source online ACP COVID-centric resources for use by nursing homes.