Using Normalisation Process Theory to explore an interprofessional approach to Goals of Care: a qualitative study of stakeholders' perspectives.

Goals of Care (GOC) is a longitudinal, multi-setting, and interprofessional practise aiming to guide the use of life-sustaining therapies. We documented the perspectives of different stakeholders regarding their roles in GOC intervention and explored the possibility of implementing an interprofessional approach in a healthcare and social services institution. We interviewed nurses, social workers, and relatives of deceased persons and analyzed the results using an analytical framework based on the 16 mechanisms of the Normalization Process Theory. We identified barriers to implementing a sustainable interprofessional approach to GOC, such as the lack of designated leaders responsible for supporting the day-to-day provision of this rather complex intervention, the difficulty of access to physicians in two of the three care settings under study, and the lack of a robust informational system. We also demonstrated that the GOC intervention is postponed until there is no uncertainty to deal with, i.e., at the end of life. Our study adds to an emerging body of literature criticising the concept of making advance medical directives itself. We advocated for the promotion of tools that would enable lay people to select and empower a supportive decision maker to better represent them in serious illness decision making. [ABSTRACT FROM AUTHOR]