RT Journal Article
SR Electronic
T1 ‘Not yet’ and ‘Just ask’: barriers and facilitators to advance care planning—a qualitative descriptive study of the perspectives of seriously ill, older patients and their families
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP 54
OP 62
DO 10.1136/bmjspcare-2013-000487
VO 5
IS 1
A1 Jessica Simon
A1 Pat Porterfield
A1 Shelley Raffin Bouchal
A1 Daren Heyland
YR 2015
UL http://spcare.bmj.com/content/5/1/54.abstract
AB Objectives To explore seriously ill, older hospitalised patients’ and their family members’ perspectives on the barriers and facilitators of advance care planning (ACP). Methods We used qualitative descriptive study methodology to analyse data from an interviewer administered, questionnaire-based, Canadian multicentre, prospective study of this population. Results Three main categories described these barriers and facilitators: (1) person (beliefs, attitudes, experiences, health status), (2) access (to doctors and healthcare providers, information, tools and infrastructure to communicate ACP preferences) and (3) the interaction with the doctor (who and how initiated, location, timing, quality of communication, relationship with doctor). Conclusions Based on the findings, we suggest strategies for both healthcare systems and individual healthcare providers to improve the quality and quantity of ACP with this population. These include assessing readiness for participation in ACP and personalising relevance of ACP to each individual, routinely offering scheduled family meetings for exploring a person's own goals and sharing information, ensuring systems and policies are in place to access previous ACP documentation and ensuring doctors’ education includes ACP communication skills.