Advance Care Planning: Identifying System-Specific Barriers and Facilitators

Hagen, Neil A.; Howlett, Jonathan G.; Sharma, Nishan; Biondo, Patricia; Holroyd‐Leduc, Jayna; Fassbender, Konrad; Simon, Jessica

doi:10.3747/co.22.2488

Cited by 19 publications

(39 citation statements)

References 11 publications

(13 reference statements)

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“…The perception of poor patient understanding and lack in patient readiness as barriers to ACP was consistent with other studies (Hagen et al, 2015;De Vleminck et al, 2013;Zhou et al, 2010). Increasing public awareness of the importance and process of ACP is essential to facilitate ACP discussions.…”

Section: Discussionsupporting

confidence: 75%

“…In addition, lack of education and perceived lack of skill by physicians and other healthcare providers were reported as major barriers by Hagen et al (2015) andDe Vleminck et al (2013). In contrast, personal experience, previous education and training, and comfort with the topic were viewed as significant facilitators to ACP.…”

Section: Discussionmentioning

confidence: 99%

“…The least rated barriers were lack of electronic medical record The results of this study are consistent with evidence found in the literature on the barriers and facilitators to ACP by providers. Inadequate time for ACP discussions has been well documented as a significant barrier to ACP by both NPs and physicians (Dube et al, 2015;Hagen et al, 2015;De Vleminck et al, 2013). The respondents expressed that numerous outcome measures that must be completed during each visit take precedence over ACP discussions.…”

Section: Discussionmentioning

confidence: 99%

“…However, lack of education on ACP and EOL care issues has been reflected in numerous studies (De Vleminck et al, 2013;Dube et al, 2015;Hagen et al, 2015). More comprehensive palliative and EOL care content needs to be incorporated into undergraduate and graduate curriculums to equip nurses and APRNs with the knowledge and skills to address ACP, especially for patients and families dealing with serious illness and EOL.…”

Section: Recommendations and Implications For Advanced Nursing Practicementioning

confidence: 99%

“…Research evidence has shown that lack of education for physicians and NPs is a major barrier in EOL care discussion (De Vleminck et al, 2013;Dube, McCarron, & Nannini, 2015;Hagen et al, 2015). shown an improvement in palliative care content in the curriculum as well as an increase in the number of hours spent on EOL content in the curriculum (Malloy et al, 2008).…”

Section: Advance Care Planning In the Curriculummentioning

confidence: 99%

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Nurse Practitioner Perspectives on the Barriers and Facilitators of Advance Care Planning

Dellava¹

2017

Preprint

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Every year, thousands of residents in the United States die while receiving end of life (EOL) care that is inconsistent with their wishes. Research evidence has shown that advance care planning (ACP) improves congruity between patients' preference and actual care received at EOL. Despite medical guidelines supporting ACP, these discussions rarely occur. The purpose of this study was to explore the perspectives of nurse practitioners (NPs) on the barriers and facilitators of ACP. The web-based ACP survey was distributed to the members of the New Hampshire Nurse Practitioner Association (NHNPA). The participants (n = 65) were mostly women (96.9%), had a Master's degree (83.1%), and had 16 to 25 years of practice as NPs (37.5%). Results indicated that the most common barriers to ACP were related to time including type of appointment, lack of time, and length of appointment. The most common facilitators were personal experience, comfort with the topic, long-term relationship with the patient, and previous education and training. Implications for advance nursing practice include conducting research on the patients' perspective on ACP, and development of evidence-based tools and methods to facilitate ACP discussions. Improving education and training of healthcare providers on ACP and EOL care issues, increasing advocacy for payment and scheduling systems that facilitate ACP, supporting policies that require ACP to patients with chronic, progressive or terminal conditions, and improving public awareness of ACP are recommended.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%