Knowledge regarding advance care planning: A systematic review

Schiffman, Ile Kermel; Werner, Perla

doi:10.1016/j.archger.2017.07.012

Cited by 68 publications

(78 citation statements)

References 56 publications

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“…Many studies identified additional education and training as necessary for healthcare professionals to undertake ACP (Beck et al, ; Downe‐Wamboldt et al, ; Duke & Thompson, ; Jezewski & Feng, ; Jezewski et al, ; Lipson et al, ; Putman‐Casdorph et al, ; Snyder et al, ). Nurses tended to know about the generalities of ACP but lacked an in‐depth knowledge of the law, which is in keeping with a previous review outlining nurses’ knowledge of advance care planning (Kermel‐Schiffman & Werner, ). This is understandable; however, at times the lack of knowledge was so great that it could undermine the process of ACP.…”

Section: Discussionsupporting

confidence: 64%

“…There is a requirement for greater education and training of nurses, and others, to help them understand both ADs and the ACP process. This has been a frequent recommendation of previous studies and reviews (Jabbarian et al, 2018;Ke et al, 2015;Kermel-Schiffman & Werner, 2017). In particular, it is important for nursing staff to be aware of their legal and professional obligations to protect patients, but also to ensure they do not face punishment themselves.…”

Section: Discussionmentioning

confidence: 98%

“…Several systematic reviews have focussed on either healthcare professionals' knowledge (Kermel-Schiffman & Werner, 2017), attitudes (Ke, Huang, O'Connor, & Lee, 2015) or practices (Jabbarian et al, 2018) towards ACP, mainly exploring these categories independently. The advantage of focussing on KAPs is that all domains of knowledge, attitude and practices are assessed, and these can be analysed in relation to each other, exploring potential interactions.…”

Section: Introductionmentioning

confidence: 99%

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Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

Blackwood

Walker

Mythen

et al. 2019

Journal of Clinical Nursing

110

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Introduction Advance care planning is a means for patients to communicate their wishes, fears and desires for future health decisions should they lose the ability to consider or communicate these. Despite being supported by governments and healthcare leaders, uptake amongst the general population remains low. Nurses play a crucial role in promoting and engaging with these discussions given their close relationship with patients and families in a range of clinical settings. Aim To describe the barriers that nurses and healthcare professionals believe prevent them from exploring advance care planning with their patients. Method We carried out a systematic review of peer‐reviewed journal articles from the databases MEDLINE, Embase, CINAHL Plus, Web of Science and ProQuest Central, guided by the PRISMA checklist. Results Eleven articles were identified: all were self‐reporting surveys using a mix of open and closed questions. They originated in the USA, Canada, Australia and Ireland. The participants included various healthcare professionals, with the majority of studies focussing on nurses. The two most important barriers to advance care planning are lack of education and insufficient time. Advance care planning appears to be well supported, and nurses and healthcare professionals report themselves to be comfortable and confident to take on the responsibility. Conclusion There is a need for greater education and training for nurses and healthcare professionals. In particular, there needs to be better understanding of professional and legal responsibilities. The need for sufficient time to be made available to allow these conversations, in often busy settings, will need institutional and financial support. Relevance to clinical practice Increased training and knowledge are likely to lead to more positive attitudes and greater confidence for nurses, and other healthcare professionals, which should help support and encourage patient engagement with advance care planning.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

Blackwood

Walker

Mythen

et al. 2019

Journal of Clinical Nursing

110

View full text Add to dashboard Cite

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“…For example, increasing knowledge of chronic diseases (eg, hypertension, diabetes, and asthma) among those with LHL results in improved health outcomes (eg, medication and appointment adherence and lower morbidity) . While studies are limited and results are mixed, education‐based interventions have been shown to increase patients' knowledge about ACP, and ACP knowledge has been associated with a higher rate of completion of advance directives . Given the role of knowledge as a mediator for improved health outcomes, ACP interventions that increase knowledge are critical, particularly for patients with LHL.…”

Section: Discussionmentioning

confidence: 99%

“…Studies exploring the relationship between ACP knowledge and prior ACP experience are limited; and they primarily include small qualitative or quantitative studies of homogeneous populations, do not include definitions of ACP beyond advance directives, or do not adjust by health literacy or language. 12,13,26 In a study evaluating the quality of POLST decisions, there was discordance between patients' current preferences and knowledge about their prior documented POLST orders. 27 In addition, a study among older hospitalized adults found that in nearly 70% of cases, documented orders regarding treatment intensification (including code status) were discordant with patients' current preferences or understanding.…”

Section: Discussionmentioning

confidence: 99%

Health Literacy Matters More Than Experience for Advance Care Planning Knowledge Among Older Adults

Nouri

Barnes

Volow

et al. 2019

J American Geriatrics Society

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BACKGROUND Advance care planning (ACP) engagement is low among vulnerable populations, including those with limited health literacy (LHL). Limited knowledge about ACP may be a modifiable mediator of the relationship between LHL and ACP. Our goal was to determine whether health literacy is associated with ACP knowledge. DESIGN Cross‐sectional design. SETTING A public health delivery system and Veterans Affairs Medical Center in San Francisco, CA. PARTICIPANTS English‐ and Spanish‐speaking patients (N = 1400). MEASUREMENTS ACP knowledge was assessed with seven validated multiple‐choice questions. Health literacy was measured using a validated scale. Sociodemographic measures included age, sex, language, education, race, health status, and social support. Prior ACP experience was defined as having documented legal forms and/or goals‐of‐care discussions in the medical record. We used Kruskal‐Wallis tests and linear regression to examine associations of ACP knowledge with LHL, prior ACP experience, and sociodemographic factors. RESULTS Mean age of participants was 65 (±10) years, 48% were women, 34% had LHL, 32% were Spanish speaking, 47% had high school education or less, and 70% were nonwhite. Mean 7‐point knowledge scores were lower for those with limited vs adequate health literacy (3.8 [SD = 1.9 vs 5.5 (SD = 1.7); P < .001). In multivariable analysis, ACP knowledge scores were 1.0 point lower among those with LHL; 0.6 points lower among Spanish speakers and those with high school education or less; and 0.5 points lower among individuals of nonwhite race (P < .001 for all). Knowledge scores were 0.02 points lower per year of older age (P = .007) and 0.01 points higher per point of greater social support (P = .005). Prior ACP experience was not associated with knowledge after adjustment (P = .7). CONCLUSIONS Health literacy and sociodemographics are stronger predictors than prior ACP experience of ACP knowledge. This study suggests that providing easy‐to‐understand ACP materials is paramount and should be offered even if patients have previous experience with the ACP process. J Am Geriatr Soc 67:2151–2156, 2019

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Cancer patients' expectations of advance care planning: A typological content analysis of qualitative interviews

Pedrosa,

Demel,

Riera Knorrenschild

et al. 2023

Psycho-Oncology

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BackgroundAdvance care planning (ACP) can help to elicit cancer patients' preferences in a discussion process to promote person‐centred medical decision‐making. Expectations are known to be highly relevant determinants of decisional processes. So far, however, little is known about cancer patients' expectations of ACP that lead to acceptance or refusal of the programme. The presented study, therefore, aims to explore cancer patients' expectations of ACP.MethodsSemi‐structured interviews were conducted with a purposeful sample of 27 cancer patients consenting to or refusing a newly implemented ACP programme in a German university hospital. Data were analysed using typological content analysis.ResultsWe identified five different expectation clusters in relation to ACP. Consenting participants held expectations about the impact of ACP that were either ‘ego‐centred’ or ‘family‐centred’. Refusers had expectations based on ignorance and misinformation, or—if they had already completed an advance directive—expectations to avoid unpleasant redundancy, perceiving no additional benefit but a burden from ACP. Finally, refusers in particular expressed expectations of delegated responsibility at the end of life, including anticipation of proxy decision‐making.ConclusionOur study results suggest that expectation‐modifying measures could be taken to positively influence cancer patients' expectations and thus the acceptance of ACP. In this respect, reducing ignorance and misguided expectations plays a decisive role. Especially in family constellations with expected delegation of responsibility and dependence at the end of life, it might be important to promote ACP as a family‐intervention to improve family outcomes.

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Knowledge regarding advance care planning: A systematic review

Cited by 68 publications

References 56 publications

Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

Health Literacy Matters More Than Experience for Advance Care Planning Knowledge Among Older Adults

Cancer patients' expectations of advance care planning: A typological content analysis of qualitative interviews

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