Search

Background. Advance care planning (ACP) is considered to be an integral part of end-of-life care. This study explored the facilitators and barriers of ACP by consolidating the practice experiences of a group of healthcare professionals involved in an outreach end-of-life programme for older people living residential care homes for the elderly (RCHEs). Methods: Fourteen healthcare professionals participated in this qualitative study. They first completed a questionnaire to capture their views on ACP by describing a successful case. Then they took part in a focus group to discuss desired outcomes, facilitators, and barriers of ACP. Thematic analysis was applied to the questionnaire and focus group data. Results: Participants considered ACP a valuable opportunity for older people to express their care preferences. The resultant care plan provides families and care teams a useful reference for treatment decision-making. Facilitators included the collaborative ties among the community geriatric assessment team, RCHE staff, and the families of patients; dedicated and trained staff; and well-informed family members. Barriers included delayed referral, a lack of public acceptance and awareness, and overwhelming routines among healthcare professionals. Conclusions: Our findings underscore the multitude of individual, family, staff, and social factors affecting the dynamic process of ACP. An effective collaborative framework and professional training in communicating with distressed families are required. In addition, enhancing public awareness of comfort care and ACP is crucial. [ABSTRACT FROM AUTHOR]

Background: Advance care planning is a process of discussion that enables competent adults to express their wishes about end-of-life care through periods of decisional incapacity. Although a number of studies have documented social workers' attitudes toward, knowledge about, and involvement in advance care planning, the information is fragmented. The purpose of this review was to provide a narrative synthesis of evidence on social workers' perspectives and experiences regarding implementation of advance care planning. Methods: Six databases were searched for peer-reviewed research papers from their respective inception through December 2016. All of the resulting studies relevant to both advance care planning and social worker were examined. The findings of relevant studies were synthesized thematically. Results: Thirty-one articles met the eligibility criteria. Six research themes were identified: social workers' attitudes toward advance care planning; social workers' knowledge, education and training regarding advance care planning; social workers' involvement in advance care planning; social workers' perceptions of their roles; ethical issues relevant to advance care planning; and the effect of social work intervention on advance care planning engagement. The findings suggest that there is a consensus among social workers that advance care planning is their duty and responsibility and that social workers play an important role in promoting and implementing advance care planning through an array of activities. Conclusions: This study provides useful knowledge for implementing advance care planning through illustrating social workers' perspectives and experiences. Further studies are warranted to understand the complexity inherent in social workers' involvement in advance care planning for different life-limiting illnesses or within different socio-cultural contexts. [ABSTRACT FROM AUTHOR]

Objective: An advance directive (AD) is a document that allows mentally competent individuals to make healthcare decisions about their condition that they might no longer be able to make in the future. This study aimed to explore the perceptions of AD decision-making of various stakeholders in the Chinese palliative care setting., Methods: Patients with life-limiting diseases, family members, health professionals, and hospital volunteers were recruited in the palliative care unit of two hospitals in Hong Kong by purposive sampling on age and sex. Qualitative semi-structured individual interviews were conducted., Results: A total of 96 participants, including 24 participants from each group, completed the study. Most participants were willing to discuss AD but had not heard about it before the interview. Patients regarded the decisions made in the AD as a way to reduce their future sufferings, while they also considered the welfare of their family. Family members were concerned about the psychological burden when discussing about the AD. Health professionals emphasized the logistic and process of the AD. Hospital volunteers pointed out the impact of Chinese culture on AD acceptance and the lack of AD promotion in the community., Conclusions: The findings of the study indicated the need for more promotion of AD in the society. It is important to consider the opinion of a patient's family during AD discussions in a Chinese culture. Health professionals may need to identify the best timing for the discussion of AD with patients and their families., Competing Interests: There is no conflicts of interest.