Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies

Ke, Li-Shan; Huang, Xiaoyan; O'Connor, Margaret Mary; Lee, Susan

doi:10.1111/jocn.12853

Cited by 113 publications

(145 citation statements)

References 37 publications

(154 reference statements)

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…The study from Canadian scientists disclosed that only 19% of physicians would discuss the AD issues in general, while more than half of them reported they would not to comply with their patients’ (AD) will expressed in in certain situation [22]. Similar results were reported by Japanese scholars: 55% of study participants (physicians) support AD application, while 33% of them had a possibility to discuss it with their patients in clinical practice [23]. …”

Section: Discussionmentioning

confidence: 68%

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Peičius

Blaževičienė

2017

BMC Med Ethics

View full text Add to dashboard Cite

BackgroundThis paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals’ understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania.MethodsA cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods.ResultsThe analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents’ profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice.Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives.ConclusionsThe study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD’s improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

show abstract

Section: Discussionmentioning

confidence: 68%

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Peičius

Blaževičienė

2017

BMC Med Ethics

View full text Add to dashboard Cite

show abstract

“…21,22 The importance of effective MDT working, and the contribution of community nurses who are described as 'distressingly overstretched', was widely reflected in the present results and has been described previously. 23,24 Community nursing is highly valued by GPs, particularly in terms of building relationships with patients at the end of their lives and with their families, delivering symptom-control medication, completing holistic assessments, and taking a proactive role in advanced care planning discussions. A lack of responsive services, particularly access to hands-on nursing or social care, was also highlighted.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Providing end-of-life care in general practice: findings of a national GP questionnaire survey

et al. 2016

View full text Add to dashboard Cite

BackgroundWith increasing numbers of people living with complex life-limiting multimorbidity in the community, consideration must be given to improving the organisation and delivery of highquality palliative and end-of-life care (EOLC). AimTo provide insight into the experience of GPs providing EOLC in the community, particularly the facilitators and barriers to good-quality care. Design and settingA web-based national UK questionnaire survey circulated via the Royal College of General Practitioners, NHS, Marie Curie, and Macmillan networks to GPs. MethodResponses were analysed using descriptive statistics and an inductive thematic analysis. ResultsResponses were received from 516 GPs, who were widely distributed in terms of practice location. Of these, 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data: continuity of care -which can be difficult to achieve because of resource concerns including time, staff numbers, increasing primary care workload, and lack of funding; patient and family factors -with challenges including early identification of palliative care needs and recognition of the end of life, opportunity for care planning discussions, and provision of support for families; medical management -including effective symptomcontrol and access to specialist palliative care services; and expertise and training -the need for training and professional development was recognised to enhance knowledge, skills, and attitudes towards EOLC. ConclusionThe findings reveal enduring priorities for policy, commissioning, practice development, and research in future primary palliative care.

show abstract

“…In particular, there is a dearth of studies concerning ACP among nurses, an important group of clinicians, especially for individuals with serious illness. Nurses play a central role in providing clinical care and patient education and support during important medical decisions . Although it is known that healthcare providers’ ACP attitudes and preferences may influence those of their patients, the ACP use of nurses has received very limited study …”

mentioning

confidence: 99%

“…Nurses play a central role in providing clinical care and patient education and support during important medical decisions. [13][14][15] Although it is known that healthcare providers' ACP attitudes and preferences may influence those of their patients, [16][17][18][19] the ACP use of nurses has received very limited study. 20,21 Thus the purpose of this study was to evaluate predictors of patient-clinician ACP discussions and those of ACP documentation (that may differ from each other 22 ) among older community-dwelling nurses.…”

mentioning

confidence: 99%

Predictors of Advance Care Planning in Older Women: The Nurses’ Health Study

Kang

Bynum

Zhang

et al. 2018

J American Geriatrics Society

View full text Add to dashboard Cite

BACKGROUND/OBJECTIVES Relatively little is known regarding predictors of advance care planning (ACP) in former nurses. We aimed to evaluate potential predictors of ACP documentation and discussion. DESIGN Cross‐sectional study, 2012‐2014. SETTING Nurses’ Health Study. PARTICIPANTS A total of 60,917 community‐dwelling female nurses aged 66 to 93 years living across the United States. MEASUREMENTS Based on self‐reports, participants were categorized as having (1) only ACP documentation, (2) ACP documentation and a recent ACP discussion with a healthcare provider, or (3) neither. Multivariable log‐binomial models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of the two separate ACP categories vs those with neither. We evaluated various demographic, health, and social factors. RESULTS The large majority (84%) reported ACP documentation; 35% reported a recent ACP discussion. Demographic factors such as age and race were associated with both ACP categories. In multivariable analyses, race was most strongly associated: compared with whites, African Americans were 27% less likely (PR = 0.73; 95% CI = 0.69‐0.78) to report ACP documentation alone and 41% (PR = 0.59; 95% CI = 0.54‐0.66) less likely to report documentation with discussion. Additionally, health/healthcare‐related characteristics were more strongly associated with ACP documentation plus discussion. Women with functional limitations (PR = 1.15; 95% CI = 1.10‐1.20), women who were recently hospitalized (PR: 1.10; 95% CI = 1.08‐1.12) or women who had seen a physician for health symptoms (PR = 1.43; 95% CI = 1.35‐1.52) or screening (PR = 1.40; 95% CI = 1.32‐1.49) were more likely to report having both ACP documentation and discussion. Social factors showed limited relationships with ACP documentation only; for documentation plus discussion, being widowed and living alone was associated with higher prevalence (PR = 1.21; 95% CI = 1.19‐1.24) and having little emotional support was associated with lower prevalence (PR = 0.84; 95% CI = 0.81‐0.86). CONCLUSIONS Among older nurses, most of whom reported having documented ACP, 35% reported recent patient‐clinician ACP discussions, indicating a major participatory gap in an element critical to ACP effectiveness. Even in nurses, African Americans reported less ACP documentation or discussion. J Am Geriatr Soc 67:292–301, 2019.

show abstract

Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies

Abstract: The findings provide nurses and administrators with information to develop related policies and education. Additionally, the appointment of nurses to formal roles related to advance care planning is appropriate and warranted.

Cited by 113 publications

References 37 publications

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Providing end-of-life care in general practice: findings of a national GP questionnaire survey

Predictors of Advance Care Planning in Older Women: The Nurses’ Health Study

Contact Info

Product

Resources

About