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

Abstract

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.