Background Advance Care Planning (ACP) in the context of end-of-life care has been identified as ‘everyone’s responsibility’. However, the research literature tends to focus only on the roles and responsibilities of medical and nursing staff and students. The relative engagement and experiences of the diverse group of health professionals in providing ACP has been underexplored in the hospital setting.
Methods This research was conducted using Mixed Methods Phenomenological Research (MMPR). Three separate studies were undertaken: a retrospective chart audit evaluating the prevalence of ACP documents health records; a survey exploring perspectives of providing ACP; and an interview study investigating perceived roles and responsibilities in providing ACP. Participants were health professionals from medical, nursing, and allied health workforce groups across a regional health service in Queensland, Australia.
Results The Role Identity Equilibrium Process was used as a theoretical model for conceptualising ACP provision. The prevalence of ACP documents in the health records was low, with only 7% of records containing a formal document. Discussions about ACP with a patient or their decision maker were documented in 48.3% of health records. Health professionals did not share a common understanding of the end-of-life time frame, nor the full extent of activities considered part of ACP. Apart from doctors, other health professionals did not identify a legitimate role in ACP. Self-perceived confidence, knowledge, and skills were low, which contributed to lack of an individual or collective professional identity, and abdication of responsibility for conducting ACP.
Conclusion Implications for clinical practice include defining roles, responsibilities, and scope of practice for novice and experienced health professionals and including a broader range of health professionals in education programs. Changes to roles and responsibilities will need to be managed sensitively, slowly, and in a safe environment that respects and builds upon existing skills and knowledge.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.