Medical practitioners' knowledge and self‐reported practices of substitute decision making and implementation of advance care plans

Abstract

Respect for patient wishes expressed in advance directives is reassuringly high. The findings suggest significant misunderstanding by medical practitioners of terminologies and systems around substitute decision-making for incompetent persons. Further education and standardisation of terminologies and systems across different jurisdictions would assist in addressing these issues. Low response rate, relating to only one legal jurisdiction, means results may not be generalisable.

General practice palliative care: patient and carer expectations, advance care plans and place of death—a systematic review

“…The quality was variable: qualitative studies rated between moderate to high; 36 37 39 , poor to high for cross-sectional studies; 41 43 44 51 54 and moderate to high for cohort studies. 36 Two studies included patient perspectives or outcomes 45 48 . One study included a wide variety of health professionals including GPs, community nurses, palliative care specialists and nurses, psychogeriatricians and a wide range of allied health professionals, and volunteers.…”

Do medical oncology patients and their support persons agree about end‐of‐life issues?

“…22,31 Support persons and providers may be concerned that patients will be unnecessarily distressed if end-of-life issues are raised 32 and may perceive that they lack the skills necessary to discuss these issues or be apprehensive of legal issues. 33,34 These findings emphasise the need for strategies that allow patients to make their preferences known to support persons and healthcare providers while they still have the capacity to do so. Interventions have typically focused on increasing the uptake of advance directives as a means of achieving patient end-of-life preferences.…”

Radiation oncology outpatients’ patterns of life expectancy discussions

“…GPs are a frequent point of contact for cancer patients (Mitchell, 2008). Similarly, nurses are often perceived as the link between patients and other members of the healthcare team (Cartwright, Montgomery, Rhee, Zwar, & Banbury, 2014;Halcomb, Daly, Jackson, & Davidson, 2004). Radiation therapists may be called on to provide psychosocial support and encounter requests for life expectancy information in the context of conversations about treatment outcomes (Elsner, Naehrig, Halkett, & Dhillon, 2017;Halkett & Kristjanson, 2007).…”