Barriers to Advance Care Planning Implementation in Health care: An Umbrella Review with Implications for Evidence‐Based Practice

Poveda-Moral, Silvia; Falcó‐Pegueroles, Anna; Ballesteros, Mónica; Bosch-Alcaraz, A.

doi:10.1111/wvn.12530

Cited by 18 publications

(12 citation statements)

References 33 publications

(128 reference statements)

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“…On the basis of individuals identifying themselves as social workers in their tweets or tweets from large social work organizations, another profession that appeared to be leading conversations regarding ACP and NHDD was that of social workers. Research indicates a lack of consensus among health care practitioners as to who is best suited to lead ACP conversations [ 62 ]; however, we see that social workers are currently a part of this process, which past work looking at ACP may have overlooked. Here, social workers may have a large presence in tweets as their profession generally involves them in EOL conversations and, subsequently, in ACP and the completion of AD forms.…”

Section: Resultsmentioning

confidence: 99%

Exploring Web-Based Twitter Conversations Surrounding National Healthcare Decisions Day and Advance Care Planning From a Sociocultural Perspective: Computational Mixed Methods Analysis

Lattimer¹,

Tenzek²,

Ophir³

et al. 2022

JMIR Form Res

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Background Within the cultures and societies of the United States, topics related to death and dying continue to be taboo, and as a result, opportunities for presence and engagement during the end of life, which could lead to a good death, are avoided. Several efforts have been made to help people engage in advance care planning (ACP) conversations, including completing advance care directives so that they may express their goals of care if they become too sick to communicate their wishes. A major effort in the United States toward encouraging such challenging discussions is the annual celebration of the National Healthcare Decisions Day. Objective This study aimed to explore ACP from a sociocultural perspective by using Twitter as a communication tool. Methods All publicly available tweets published between August 1, 2020, and July 30, 2021 (N=9713) were collected and analyzed using the computational mixed methods Analysis of Topic Model Network approach. Results The results revealed that conversations driven primarily by laypersons (7107/7410, 95.91% of tweets originated from unverified accounts) surrounded the following three major themes: importance and promotion, surrounding language, and systemic issues. Conclusions On the basis of the results, we argue that there is a need for awareness of the barriers that people may face when engaging in ACP conversations, including systemic barriers, literacy levels, misinformation, policies (including Medicare reimbursements), and trust among health care professionals, in the United States. This is incredibly important for clinicians and scholars worldwide to be aware of as we strive to re-envision ACP, so that people are more comfortable engaging in ACP conversations. In terms of the content of tweets, we argue that there is a chasm between the biomedical and biopsychosocial elements of ACP, including patient narratives. If used properly, Twitter conversations and National Health Care Decision Day hashtags could be harnessed to serve as a connecting point among organizations, physicians, patients, and family members to lay the groundwork for the trajectory toward a good death.

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Section: Resultsmentioning

confidence: 99%

Exploring Web-Based Twitter Conversations Surrounding National Healthcare Decisions Day and Advance Care Planning From a Sociocultural Perspective: Computational Mixed Methods Analysis

Lattimer¹,

Tenzek²,

Ophir³

et al. 2022

JMIR Form Res

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“…40,42,49 This is in line with recent research stating that there may be different barriers to implementation of ACP interventions in different clinical settings and that adapting the interventions into clinical contexts may be one of these barriers. 73,74 One of the conclusions in the study by Winterbottom et al 6 describing the decision map around pathways, options, and decisions when managing chronic kidney disease is to signpost EoLC decisions early in the pathway. This states the importance of considering implementation of the intervention throughout the development phase to be aware of potential barriers along the way.…”

Section: Discussionmentioning

confidence: 99%

Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review

Buur

Bekker

Madsen

et al. 2023

JBI Evidence Synthesis

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Objective: The objective of this review was to investigate and map empirical evidence of patient involvement interventions to support patients with kidney failure making end-of-life care decisions in kidney services. Introduction: Clinical guidance integrating end-of-life care within kidney failure management pathways varies. Advance care planning interventions aimed at involving patients with kidney failure in their end-of-life care planning are established in some countries. However, there is limited evidence of the other types of patient involvement interventions integrated within services to support patients with kidney failure in making decisions about their end-of-life care. Inclusion criteria: This scoping review included studies exploring patient involvement interventions evaluated for patients with kidney failure considering end-of-life care, their relatives, and/or health professionals in kidney services. Studies of children under the age of 18 years were excluded. Methods: The review was informed by JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines. MEDLINE, Scopus, Embase, and CINAHL were searched for full-text studies in English, Danish, German, Norwegian, or Swedish. Two independent reviewers assessed the literature against the inclusion criteria. A relational analysis framework was used to synthesize the data extracted from the included studies, and to investigate and map different patient involvement interventions. Results: The search identified 1628 articles, of which 33 articles met the inclusion criteria. A total of 23 interventions were described. Interventions targeted patients (n=3); health professionals (n=8); patients and health professionals (n=5); and patients, relatives, and health professionals (n=7). Intervention components included patient resources (eg, information, patient decision aids), consultation resources (eg, advance care planning, shared decision-making), and practitioner resources (eg, communication training). Patient involvement interventions were delivered within hospital-based kidney services. Conclusions: The review identified several ways to support patients with kidney failure to be involved in end-of-life care decisions. Future interventions may benefit from adopting a complex intervention framework to engage multiple stakeholders in the research and design of an intervention for shared decision-making between patients with kidney failure, their relatives, and health professionals about integrating end-of-life care options into their kidney disease management pathway.

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“…Incorporating evidence-based knowledge into practice is recognised as a means of reducing healthcare costs and improving health outcomes (Poveda-Moral et al, 2021). However, there are some barriers to implementing EBP (Florczak, 2017).…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators of evidence‐based physiotherapy practice in Iran: A qualitative study

ShahAli,

Kajbafvala,

Fetanat

et al. 2023

Musculoskeletal Care

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BackgroundTo facilitate evidence‐based practice (EBP) in physiotherapy in Iran and guide future improvements, it is crucial to identify what barriers and facilitators exist in the current system from the physiotherapist's perspective. Therefore, the purpose of this study was to explore the barriers and facilitators of EBP in physiotherapy in Iran.MethodsThis qualitative study was conducted using a phenomenological approach from January to July 2023 in Iran. The sampling process started with a purposive approach, and then an attempt was made to identify and interview more potential samples with the snowball approach. Thematic analysis was used to analyse the collected qualitative data.Results44 individuals, including 37 physiotherapists and seven faculty members, participated in this study. Several barriers and facilitators to evidence‐based physiotherapy practice in Iran were found and then put into three themes: (1) individual factors, (2) practice environment factors, and (3) extra‐organisational factors. The most common barriers were time/workload pressures, financial incentives, lack of motivation, weakness in English, managers' pressures, inadequate awareness among patients, infrastructure limitations, poor economic situation, Internet restrictions, inappropriateness of the educational curriculum, difficult access to scientific research, and lack of insurance coverage for up‐to‐date therapies.ConclusionsAlthough most of the participants had a very positive view of physiotherapy based on scientific evidence, various obstacles have prevented this approach from being well implemented in Iran. Therefore, it is necessary to move towards minimising the existing barriers at the individual, practice environment, and extra‐organisational levels by adopting effective multilateral policies.

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Barriers to Advance Care Planning Implementation in Health care: An Umbrella Review with Implications for Evidence‐Based Practice

Cited by 18 publications

References 33 publications

Exploring Web-Based Twitter Conversations Surrounding National Healthcare Decisions Day and Advance Care Planning From a Sociocultural Perspective: Computational Mixed Methods Analysis

Exploring Web-Based Twitter Conversations Surrounding National Healthcare Decisions Day and Advance Care Planning From a Sociocultural Perspective: Computational Mixed Methods Analysis

Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review

Barriers and facilitators of evidence‐based physiotherapy practice in Iran: A qualitative study

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