Advance Directives

Abstract

This study explored the perceptions of health care providers across the continuum of care as to how effective advance directive arrangements were in assuring compliance with the patients' wishes, as well as their overall satisfaction levels with the process. The health care providers who responded to the survey indicated high levels of overall satisfaction with advance directives, despite low patient completion rates and, most significantly, low confidence levels that surrogate decision making accurately reflected the patient's wishes. A secondary analysis compared the perceptions of health care providers with consumers' reasons for failing to complete advance directives. The need for further education was perceived as a primary need by the health care professionals but not by the consumers. Recommendations for policy initiatives and further research are then presented.

Social workers’ involvement in advance care planning: a systematic narrative review

“…Social workers reported consistently stronger beliefs than nurses regarding their role in the decision-making process and their role with patients and family members.3. Nurses were more willing than social workers to use artificial feeding and less willing to use mechanical ventilation and CPR for all conditions.Neuman & Wade, 1999 [47] (USA)To explore the perceptions of health care providers as to how effective AD arrangements were in assuring compliance with the patients’ wishes, and their satisfaction levels with the process.A cross-sectional surveyAn interdisciplinary sample of health care providers practicing in a variety of settings (response rate: 33%)1161. 64% of the respondents indicated that they had direct responsibility in overseeing the facility’s ADs program or in discussing ADs with patients’ families.2.…”

“…• A substantial proportion of respondents (1–75%) did not correctly answered relevant “true/false” questions about LST [42]. • Social workers as a group reported lower levels of satisfaction with AD laws and systems than nurses and other professionals [47]. • 73% of social workers in South Korea reported no knowledge of ADs [19].…”

“…• Common ethical issues identified through thematic analysis included preservation of patients’ autonomy/self-determination, beneficence of health care providers, and medical futility of end-of-life treatments [25]. • Social workers working in hospitals were more likely to report encountering patient and family conflict regarding treatment decisions, difficulty in communicating with the patient and family and lack of adequate guidance from the medical staff [47]. • Continued communication with all parties involved was key in resolving ethical problems [25].…”

“…Their knowledge regarding life-sustaining treatments seemed to be insufficient [42]. Compared with nurses and physicians, fewer social workers reported satisfaction with AD laws and systems [47]. Unlike those in the US, most social workers in South Korea didn’t receive education or training regarding ACP [19].…”

“…The area in which social workers reported being more involved was activities related to family members [22]. Over 64% of social workers indicated that they had direct responsibility in discussing ADs with patients’ families [47]. Compared to physicians and nurses, social workers spent more time daily in their AD communication practice with patients, but most of them reported that the time they spent in AD communications was inadequate [41, 46].…”