Healthcare Providers’ Attitudes, Knowledge, and Practice Behaviors for Educating Patients About Advance Directives: A National Survey

Abstract

Background: Advance care planning for end-of-life care emerged in the mid-1970’s to address the need for tools, such as the advance directive (AD) legal document, to guide medical decision-making among seriously ill patients, their families, and healthcare providers. Objective: Study aims examine providers’ perspectives on AD education that involve examining (1) a range of attitudes about educating patients, (2) whether prior knowledge was associated with practice behaviors in educating patients, and (3) specific factors among healthcare providers such as characteristics of work setting, knowledge, attitudes, and behaviors that may influence AD education and documentation. Design: To examine providers’ views, we conducted a cross-sectional, online survey questionnaire of healthcare providers using social media outreach methods for recruitment. Methods: This study used a cross-sectional survey design to examine the proposed aims. Healthcare providers, recruited through a broad approach using snowball methods, were invited to participate in an online survey. Logistic regression analyses were used to examine providers’ views toward AD education. Results: Of 520 participants, findings indicate that most healthcare providers said that they were knowledgeable about AD education. They also viewed providing education as beneficial to their practice. These findings suggest that having a positive attitude toward AD education and experiencing less organizational barriers indicate a higher likelihood that providers will educate patients regarding ADs. Conclusion: Various disciplines are represented in this study, which indicates that attitudes and knowledge influence AD discussions. The importance of AD discussions initiated by healthcare providers is critical to providing optimal patient-centered care.

Does the Experience of Caring for a Severely Disabled Relative Impact Advance Care Planning? A Qualitative Study of Caregivers of Disabled Patients

“…Examples include pain from sputum suction, insertion of tubes, and being restrained. Seeing the discomfort in their family members due to suffering further strengthens their negative thoughts that "living is suffering" and tends to cause caregivers to feel guilty and depressed, which is similar to the results of past studies [33,34]. Conversely, if the patient shows peaceful countenance with absence of pain, the caregiver will instead feel positive.…”

Development and Psychometric Properties of the General Public's Attitudes toward Advance Care Directives Scale in Portugal

“…Research shows that care providers miss opportunities to start a discussion about advanced care planning in part when they lack skills to initiate a conversation or prefer not to engage in discussions when seriously ill patients are feeling well. 32 In contrast, public awareness of the concept of ACD and EOL issues remains insufficient for widespread, effective and appropriate EOL care to be accepted as the norm. 33 According to the studies by Andrès-Pretel et al, 34 Chan et al, 7 Aguilar-Sanches et al, 35 most participants have favorable/ positive attitudes toward ACD.…”

English and Spanish‐speaking vulnerable older adults report many barriers to advance care planning

“…Fewer than two‐thirds of older adults in the United States have engaged in ACP discussions or documentation, with lower rates among non‐English‐speaking and racial/ethnic minority individuals 10–15 . Clinician‐related barriers to ACP include personal discomfort with discussing end‐of‐life care, fear of causing distress, lack of time and reimbursement, and lack of training 16–21 . Thus far, patient‐reported barriers include discomfort with the topic of dying, confusion with the legalese of advance directives, and lack of knowledge about medical interventions at the end of life 22–24 .…”