An integrative review of stakeholder views on Advance Care Directives (ACD): barriers and facilitators to initiation, documentation, storage, and implementation

Bronwyn Hemsley, Jacqueline Meredith, Lucy Bryant, Nathan J. Wilson, Isabel Higgins, Andrew Georgiou, Sophie Hill, Susan Balandin, Shaun McCarthy

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Objective: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. Method: An integrative review of 93 studies, analysed according to their content themes. Results: Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. Conclusions: There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. Practice Implications: It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients’ end-of-life care decisions.

LanguageEnglish
Pages1067-1079
Number of pages13
JournalPatient Education and Counseling
Volume102
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

Fingerprint

Advance Care Planning
Advance Directives
Documentation
Health Personnel
Communication Disorders
Terminal Care
Electronic Health Records
Disabled Persons
Research
Fear
Health

Keywords

  • Advance Care Directive
  • Advance care planning
  • End-of-life care
  • Patient views

Cite this

Hemsley, Bronwyn ; Meredith, Jacqueline ; Bryant, Lucy ; Wilson, Nathan J. ; Higgins, Isabel ; Georgiou, Andrew ; Hill, Sophie ; Balandin, Susan ; McCarthy, Shaun. / An integrative review of stakeholder views on Advance Care Directives (ACD) : barriers and facilitators to initiation, documentation, storage, and implementation. In: Patient Education and Counseling. 2019 ; Vol. 102, No. 6. pp. 1067-1079.
@article{24395f5ff96b45da961c195f8c4027f3,
title = "An integrative review of stakeholder views on Advance Care Directives (ACD): barriers and facilitators to initiation, documentation, storage, and implementation",
abstract = "Objective: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. Method: An integrative review of 93 studies, analysed according to their content themes. Results: Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. Conclusions: There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. Practice Implications: It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients’ end-of-life care decisions.",
keywords = "Advance Care Directive, Advance care planning, End-of-life care, Patient views",
author = "Bronwyn Hemsley and Jacqueline Meredith and Lucy Bryant and Wilson, {Nathan J.} and Isabel Higgins and Andrew Georgiou and Sophie Hill and Susan Balandin and Shaun McCarthy",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.pec.2019.01.007",
language = "English",
volume = "102",
pages = "1067--1079",
journal = "Patient Education and Counseling",
issn = "0738-3991",
publisher = "Elsevier",
number = "6",

}

An integrative review of stakeholder views on Advance Care Directives (ACD) : barriers and facilitators to initiation, documentation, storage, and implementation. / Hemsley, Bronwyn; Meredith, Jacqueline; Bryant, Lucy; Wilson, Nathan J.; Higgins, Isabel; Georgiou, Andrew; Hill, Sophie; Balandin, Susan; McCarthy, Shaun.

In: Patient Education and Counseling, Vol. 102, No. 6, 01.06.2019, p. 1067-1079.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - An integrative review of stakeholder views on Advance Care Directives (ACD)

T2 - Patient Education and Counseling

AU - Hemsley, Bronwyn

AU - Meredith, Jacqueline

AU - Bryant, Lucy

AU - Wilson, Nathan J.

AU - Higgins, Isabel

AU - Georgiou, Andrew

AU - Hill, Sophie

AU - Balandin, Susan

AU - McCarthy, Shaun

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Objective: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. Method: An integrative review of 93 studies, analysed according to their content themes. Results: Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. Conclusions: There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. Practice Implications: It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients’ end-of-life care decisions.

AB - Objective: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. Method: An integrative review of 93 studies, analysed according to their content themes. Results: Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. Conclusions: There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. Practice Implications: It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients’ end-of-life care decisions.

KW - Advance Care Directive

KW - Advance care planning

KW - End-of-life care

KW - Patient views

UR - http://www.scopus.com/inward/record.url?scp=85061807670&partnerID=8YFLogxK

U2 - 10.1016/j.pec.2019.01.007

DO - 10.1016/j.pec.2019.01.007

M3 - Review article

VL - 102

SP - 1067

EP - 1079

JO - Patient Education and Counseling

JF - Patient Education and Counseling

SN - 0738-3991

IS - 6

ER -