BACKGROUND
Within most Western societies, topics related to death and dying continue to be taboo, and opportunities for presence and engagement during end-of-life that could lead to a good death are avoided as a result. Several efforts have been made to help people engage in advance care planning (ACP) conversations, including completing advance care directives, so they may express their goals-of-care if they become too sick to communicate their wishes. One major effort in the United States towards encouraging such challenging discussions is the annual celebration of National Healthcare Decisions Day (NHDD).
OBJECTIVE
The present study explored ACP from a socio-cultural perspective, using Twitter as a communication tool.
METHODS
All publicly available tweets published between August 1st 2020 and July 30th 2021 (N = 9,713) were collected and analyzed using the computational, mixed-method Analysis of Topic Model Network (ANTMN) approach.
RESULTS
Results revealed conversations, driven primarily by laypersons (96% of tweets originated from unverified accounts) surrounded three major themes: importance and promotion, surrounding language, and finally, systemic issues.
CONCLUSIONS
Based on the results, we argue there is a need for awareness of what barriers people may face in engaging in ACP conversations, including systemic barriers, literacy levels, misinformation, policies, including Medicare reimbursements, and trust among health care professionals. This is incredibly important for clinicians and scholars to be aware of as we strive to re-envision ACP so that people are more comfortable engaging in ACP conversations. In terms of content of Tweets, we argue there is a chasm between the biomedical and biopsychosocial elements of ACP, including patient narratives. If used properly, Twitter conversations and NHDD hashtags could be harnessed to serve as a connecting point between organizations, physicians, patients and family members, to lay the groundwork for the trajectory towards a good death.