Healthcare professionals’ perceptions of advance care planning in palliative care unit: a qualitative descriptive study

Abstract

Aims and objectives To describe healthcare professionals’ perceptions of advance care planning (ACP) in palliative care unit in hospital ward or outpatient clinic. Background Clinical guidelines recommend timely ACP as a central component of patient‐centred palliative care. However, the ACP concept and terminology have been judged to be confusing, and practices are not established. Professionals’ views are needed for ACP adoption and usage. Design Qualitative descriptive design. Methods The study used purposive sampling. The data were collected through focus group interviews with registered nurses and practical nurses and individual or couple interviews with physicians and social workers. The data (n = 33) were analysed by inductive content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results Three main categories emerged: Information content of ACP, coordination of care activities through ACP, and support for patients’ and family members’ coping. The information content of ACP included assessment of need for patient care, preparing for changes in patient's state of health and proactive medication. Coordination of care activities through ACP contained ACP care planning, cooperation and work practices between healthcare professionals. Support for patients’ and family members’ coping included communication between patient, family members and professionals and promoting patient self‐care. Conclusions ACP is a useful and proactive tool for integrating patient‐centred information, care and services as well as support for patients’ and family members’ coping. Palliative care activities can be coordinated through ACP in a multidisciplinary manner. ACP is significant and relevant for both professionals’ work and patient care throughout the service system. Relevance to clinical practice Results highlight the importance of proactive, concrete and holistic ACP. ACP should be up to date to reflect patient's current wishes. Raising professional awareness and implementing ACP into work processes are essential. Results can be utilised in planning and implementing interprofessional in‐service training.

A Survey of Clinicians Regarding Goals of Care for Patients with Severe Comorbid Illnesses Hospitalized for an Acute Deterioration

“… 15 , 16 Previous studies have identified knowledge deficit and inexperience as common barriers to good ACP/GoC practice in the acute setting. 17 – 19 However, since most respondents in our survey were able to identify terminally ill patients with poor life expectancy, it may be argued that knowledge deficit was not a barrier against ACP/GoC. Similarly, skills deficit may also not be a problem since most respondents reported being comfortable with conducting ACP/GoC discussions.…”

Timely goals of care documentation in patients with frailty in the COVID‐19 era: a retrospective multi‐site study

“…level of function before the admission, social circumstances), and inexperience as common barriers to good GOC practice in the acute setting. [30][31][32][33] Moreover, there were uncertainties around the impact of this novel virus and risk of rapid deterioration, which meant that there was only a brief window for conversations to occur with patients (when able) and their family. This was complicated further by the imposition of stringent measures to minimise viral transmission risk with intricate visitor restrictions adding layers of complexity in communicating with patients and families.…”

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

“…Boddy et al reported that if healthcare professionals are uncertain about ACP, who is responsible for it, and what and how to talk about it, they may not raise these topics with patients [ 16 ]. Moreover, if healthcare professionals make sufficient preparations, they can better play the role of introducing ACP, so the opinions of healthcare professionals are equally needed, important, and useful [ 17 ]. Their perspectives can reveal existing objective problems about specialization, such as defects in the healthcare system and their urgent need for relevant skills, and thus by examining these problems, the necessary conditions for the long-term development of ACP will also be revealed.…”