Experiences and perspectives of healthcare professionals implementing advance care planning for people suffering from life-limiting illness: a systematic review and meta-synthesis of qualitative studies

Abstract

Background Life-limited patients may lose decision-making abilities during disease progression. Advance care planning can be used as a discussion method for healthcare professionals to understand patients’ future care preferences. However, due to many difficulties, the participation rate of healthcare professionals in advance care planning is not high. Aim To explore the facilitators of and barriers to healthcare professionals’ provision of advance care planning to life-limited patients to better implement it for this population. Methods We followed ENTREQ and PRISMA to guide this study. We conducted a systematic search of PubMed, Web of Science, Embase, CINAHL, PsycINFO, CNKI, and SinoMed to include qualitative data on the experiences and perspectives of healthcare professionals in different professional fields in providing advance care planning for life-limited patients. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of the included studies. Results A total of 11 studies were included. Two themes were identified: unsupported conditions and facilitative actions. Healthcare professionals regarded cultural concepts, limited time, and fragmented record services as obstacles to implementation. They had low confidence and were overly concerned about negative effects. They needed to possess multiple abilities, learn to flexibly initiate topics, and facilitate effective communication based on multidisciplinary collaboration. Conclusion Healthcare professionals need an accepting cultural environment to implement advance care planning, a sound legal system, financial support, and a coordinated and shared system to support them. Healthcare systems need to develop educational training programs to increase the knowledge and skills of healthcare professionals and to promote multidisciplinary collaboration to facilitate effective communication. Future research should compare the differences in the needs of healthcare professionals in different cultures when implementing advance care planning to develop systematic implementation guidelines in different cultures.

Views of health care professionals on the implementation of preoperative advance care planning in older patients with head and neck cancer: Q methodology

“…Therefore, it is crucial to carry out ACP education and skills training for HCPs as soon as possible to promote the practice of ACP. At the same time, HCPs with different specialties should be prompted to adopt different roles in preoperative ACP according to their own work nature and strengths [ 19 ]. In addition, limited legal and policy support has contributed to the lack of confidence in preoperative discussions among HCPs.…”

“…Therefore, improvement of the legal system and the provision of financial support may mobilize HCPs to implement preoperative . A living will with legal effect not only safeguards the patient’s autonomy but also guarantees that HCPs will carry out their diagnostic and therapeutic activities in accordance with the law and eliminates misgivings among HCPs about medical disputes arising from the implementation of ACP [ 19 ].…”

“…HCPs usually have an encouraging and guiding role in the ACP implementation process [ 18 ]. The level of knowledge and the attitudes of HCPs toward ACP affect the implementation of ACP in practical situations, and it is important for HCPs to be adequately prepared for the implementation of ACP [ 19 ]. Previous study has shown that when talking about ACP, most HCPs believe it is beneficial, yet surgical HCPs do not always have this view [ 20 ].…”

Habilidades sociais na especialidade da enfermagem em oncologia: estudo qualitativo

“…Enfermeiros especialistas em oncologia que tiveram educação em habilidades de comunicação avançadas relataram sentirem-se preparados e confiantes ao comunicar notícias difíceis aos pacientes e familiares 26,27 . A necessidade de educação para comunicar bem, dentre outras habilidades, deve estar pautada em política institucional e em modelo assistencial para comunicação centrada no paciente 28 .…”

Reliability and Validity of the Chinese Version of Advance Care Planning Self-efficacy Scale for Physicians

“…7,8 When patients lack the ability to make decisions, ACP can raise the probability that healthcare personnel will understand and comply with their patients' medical care choices, as well as lower the risk of doctor-patient disagreements developing. 9,10 For society, ACP can reduce patient hospitalization rates, reduce the waste of medical resources, and promote the development of hospice care. 11 As the Chinese aging society is coming, an increasing number of individuals and families will suffer from illnesses and deaths.…”