Critical Appraisal of Healthcare Article: Long-Term Care Facilities

This report presents a critical appraisal of the systematic review article by Mignani et al. (2017), which investigates the perspectives of older adults residing in long-term care facilities and their family members concerning advance care planning (ACP) discussions. The appraisal assesses the article's focus, methodology, and inclusion criteria, confirming a clear research question and appropriate literature search strategies using databases like PubMed, CINAHL, and PsycINFO. The report evaluates the inclusion of relevant studies, the assessment of study quality (though lacking conclusive evidence), and the reasonableness of combining results. It highlights key findings, such as the positive attitudes towards ACP among elderly residents and their families, while also acknowledging instances where communication barriers or lack of knowledge hindered these discussions. The report further examines the precision of the results, their applicability to local populations, and the consideration of all important outcomes. The appraisal concludes by evaluating whether the benefits of the study outweigh the potential harms and costs, ultimately providing a comprehensive analysis of the article's strengths and limitations within the context of healthcare research.

Running head: CRITICAL APPRAISAL
Critical Appraisal
Name of the Student
Name of the University
Author Note

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1. Did the review address a clearly focused question? Justify why this appraisal was
chosen?
Ans- yes the review article clearly address the focused question. The primary focus
of this study, is associated with the perspective of the older adults living in the long-
term care facilities and along with this the study also focuses towards the perspective
of the family members of the of the older people regarding the advance care planning
process (Mignani et al., 2017). This article was chosen for appraisal since it clearly
describes the fact that older adults stay longer in healthcare facilities. This paper also
justifies the persipective of the family members of the associated older people towards
their long term in a healthcare facility. Advance care planning procedures are also
discussed in this paper which clearly justifies the fact that older people stays longer in
health care facilities.
2. Did the authors look for the right type of papers?
Ans- Yes, the researchers used the right type of papers for this systematic review
study. From the research study, it is reported that, the researchers used the ENTREQ
(enhancing transparency in reporting the synthesis of qualitative research) framework
in this review process. The databases such as PubMed, CINAHL, PsycINFO were
used to search the literature and all the literature published in between January 2000
and November 2015 were considered as relevant for this study. The researchers also
used the relevant key words such as “ advance health care, advance health care plan,
residential facilitator, nursing home, interviews, long term care, family, older persos,
elder, relative, care homes”. The systematic review study also has an appropriate
study design and a systematic review and thematic analysis were performed by using
the qualitative studies investigating the attitudes of the older people who are living in

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a long term care facilities and their family members’ attitude also analysed through
this systematic study (Mignani et al., 2017).
3. Do you think all the important, relevant studies were included?
Ans- Yes, all important studies are included in the systematic review study. All the
inclusion criteria were maintained during the selection of the studies. The study that
addresses the problem of people who are under the age group of 65 year or more.
Along with this, the studies, that are published in English were included for the
systematic review. The studies that address the problem of the people younger than 65
years were not included in the systematic review (Mignani et al., 2017). The studies
which were published as book chapters, abstracts or as dissertation were not included
in this study as well. The mixed method studies or qualitative studies were included in
this study as well. Apart from that , the authors were also independently screened the
abstracts and titles of the articles and from that screening process all the relevant
articles were included for the final review. Moreover, two reviewers also screened full
text articles as well for the final review (Mignani et al., 2017).
4. Did the review’s authors do enough to assess quality of the included studies?
Ans- In this regard, any type of conclusive evidence of assessing the quality of
studies selected in the final review process was not present in the current study.
Therefore, this section cannot be told properly (Mignani et al., 2017).
5. If the results of the review have been combined, was it reasonable to do so?
Ans- Yes, the study results of all the studies were used for the systematic review
were included in this study. The review study result indicated that, finally 729 articles

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were involved after removing the duplicate studies. After completing the screening
process of the articles, 64 articles were analysed critically and only 9 articles were
selected for the final systematic study. The study result showed that, some studies
found that, the people under the age group of 65 years or above had initially planned
for the practical issues related the death of themselves (Mignani et al., 2017). Along
with this, a few study also reported about the cases where elderly people made
arrangements for the period after the death and this findings reported that, individuals
are generally prepared for their related issues as well. In a few studies, the
contradictory views regarding the above context were also found. In those studies, it
was reported that, there are also a few older people who did not want to talk about the
death related incidents with the care providers of the end of life of life care. In few
studies, it was also reported that, the lack of communication among the care providers
and the older people in the end of life care home was one of the main reasons for the
older people not to share their views regarding the end of life processes. In these
studies, it was reported that, the older people who were living in the end of life care
facilities, were not comfortable to talk with the friends, families as well (Mignani et
al., 2017). However, it also may possible that, the gap in the communication process
may also be due to the introvert nature of the individuals participated in those studies.
Apart from that, it may also possible that, the elders assumed that the care providers
knew about the preferences of the individuals ; however, this factor was not
documented in the studies. In one study, a family members of the older people
assumed that, they knew about the preferences of their loved ones without even
interacting with the elder people. On the contrary, in some studies, it was also
reported that, the elderly people sometimes discussed their end of life care with their
family members and with their care providers (Mignani et al., 2017). In one study, it

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was reported that majority of the family members and the end of life care providers
had not adequate knowledge regarding the ACP and advance directives. However, a
few studies discussed the problems of the elders who complained that their wishes
were nit followed properly after their deaths. While discussing the decision making
process, it can be stated that, the attitudes of the elder people were different in case of
different people. Many residents of the early care facilities trusted staffs of the end of
life care organizations and the family members of the regarding fulfilling their
interests after their deaths (Mignani et al., 2017). On the contrary, a few elders also
wanted to participate in the decision making processes as well. Along with this, the
family members of the patients also reported about the barrier that is dementia among
the elder people in the way of communication process with the elderly people and
with the care providers. As a part of this, the study findings showed that, the elderly
people failed to recognize the family members and the care providers. Therefore,
such incidents restricts the communication process in between the elder people and
the family members and the care providers of the end of life care facilities (Mignani et
al., 2017).
6. What are the overall results of the review?
Ans- The study aimed to review the qualitative findings regarding the perspective of
the elder people living in the long term care facilities and along with the perspective
of the family members of those people about the ACP discussions. The study result,
showed that, in most of the cases, the attitudes of the elderly people and their family
members were positive regarding the ACP discussions. In two studies the study result
reported that residents and the family members showed positive intendant towards the
complex ACP intervention used in those studies (Mignani et al., 2017). The overall

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study result displayed that majority of the elders living in the long term care facilities
disclosed positive approaches about the willingness about talking about the end of life
care. However, some of the people did not want to design about the end of life;
however, the family fellows of those people understood the facilities of the ACP and
along with this, some of the elderly people did not consider that such considerations
were needed at all (Mignani et al., 2017).
7. How precise are the results?
Ans- The preciseness of the study result cannot be expressed appropriately as the
confidence interval is absent in the study. According to the findings of Olofsson et al.
(2013), it is stated that, to measure the preciseness of any kind of study, the presence of
confidence interval is very critical as it is the analytical factor of the preciseness of the
study outcome (Mignani et al., 2017).
8. Can the results be applied to the local population?
Ans- Yes, the study consequence can be useful to the local populations as in this review
study, only those studies were included which were conducted mainly in US, UK,
Belgium and Australia. As the studies were based on the settings of Australia, hence this
result can be local community. However, there is a high chance of having partiality in the
study results due to the backgrounds of the investigators (Mignani et al., 2017).
9. Were all important outcomes considered?

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Ans- Yes, all the significant consequences of the study were reflected in this review
study. The authors debated about the different views of the elderly people and their
family members. Most of the cases, it is reported that, that the family members and the
elderly people were quite satisfied with ACP facilities and on the contrary a few elderly
people did not even want to discuss about such things with the family members and as
well as with the care providers in the end life care facilities (Mignani et al., 2017).
10. Are the benefits worth the harms and costs?
Ans- The study does not identify any type of profits regarding costs and harms of the study.
Therefore, it can be specified that, the study is very much useful as it may help to recognize
the current problems regarding the end of life care facilities of the elder people living in the
long term care facilities (Mignani et al., 2017).

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References
Mignani, V., Ingravallo, F., Mariani, E., & Chattat, R. (2017). Perspectives of older people
living in long-term care facilities and of their family members toward advance care
planning discussions: a systematic review and thematic synthesis. Clinical interventions in
aging, 12, 475.
Olofsson, P., Foody, G. M., Stehman, S. V., & Woodcock, C. E. (2013). Making better use of
accuracy data in land change studies: Estimating accuracy and area and quantifying
uncertainty using stratified estimation. Remote Sensing of Environment, 129, 122-131.

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