Background Medical social workers (MSW) have been identified as one of the healthcare professionals who can drive advance care planning in Singapore. This study, using social cognitive theory, aimed to explore the perceptions and experiences of MSWs in carrying out ACP in the early days of ACP implementation in a restructured hospital, and their perceived barriers and facilitators in having ACP conversations with patients and their families.
Methods MSWs with a range of experiences in conducting ACP, were recruited through stratified sampling. Seven focus groups consisting of a total of 25 medical social workers were conducted. Various measures were taken to optimize group safety. The focus groups were conducted by an external facilitator. Thematic analysis was used to analyse the data and data saturation was reached.
Results Majority of MSWs believed that ACP conversations could promote patients’ autonomy, relieve patients’ families from stress, and contribute to holistic care. However, they were uncertain whether patients’ preferences would be upheld, as MSWs perceived inconsistencies in how physicians value and implement ACP in their practice. MSWs also felt inefficacious when discussing medical conditions and believed in the need for a multi-disciplinary approach when conducting ACP. While there is no consistent approach in identifying suitable patients for ACP, MSWs were inclined to approach patients with no next-of-kin and those at the end of their lives. Although MSWs’ skills in communication facilitated the work of ACP, the need to juggle a heavy workload and to potentially manage misaligned healthcare preferences between patients and physicians remained as barriers. MSWs reported greater conviction in the cause of ACP after gaining experience in facilitating ACP.
Conclusion This study provided insights into the perceptions and experience of MSWs in facilitating ACP conversations, and identified areas that MSWs needed support in. Providing post-training support, such as mentoring, is recommended.
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