Structure of Advance Care Planning Practice by Home Health Nurses for Multigenerational Families With Dependent Children and Terminally Ill Grandparents.

This study examines the structure of advance care planning (ACP) practices implemented by home health nurses (HHNs) for multigenerational families in Japan, specifically those with dependent children (aged 9–22 years) and terminally ill grandparents. Through interviews with 20 experienced HHNs, the research identified a two-level practice structure: foundational support focused on emotional stability and end-of-life (EOL) care for sandwich generation caregivers (SGCs)—adults caring simultaneously for children and terminally ill grandparents—and targeted practices that connect multiple generations, address children's involvement, and incorporate hands-on experiences and communication. The findings highlight the importance of supporting SGCs as key intermediaries, recognizing children's roles and readiness in ACP discussions, and facilitating experiential learning to help families navigate EOL care collaboratively. This study contributes novel insights into multigenerational ACP practices amid demographic shifts increasing the prevalence of SGCs.