Bronwyn Hemsley1, Jacqueline Meredith2, Lucy Bryant3, Nathan J Wilson4, Isabel Higgins5, Andrew Georgiou6, Sophie Hill7, Susan Balandin8, Shaun McCarthy9. 1. The University of Technology Sydney, Building 7, Faculty of Science and Graduate School of Health Building, 67 Thomas Street, Ultimo, Australia @BronwynHemsley. Electronic address: Bronwyn.Hemsley@uts.edu.au. 2. The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia. Electronic address: jacqueline.meredith@newcastle.edu.au. 3. The University of Technology Sydney, Building 7, Faculty of Science and Graduate School of Health Building, 67 Thomas Street, Ultimo, Australia @BronwynHemsley. Electronic address: Lucy.Bryant@uts.edu.au. 4. Western Sydney University, Building G10/Office 10, Hawkesbury Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia. Electronic address: N.Wilson@westernsydney.edu.au. 5. The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia. Electronic address: isabel.higgins@newcastle.edu.au. 6. Macquarie University, Room L6 36, Level 6, 75 Talavera Road, NSW, 2109, Australia. Electronic address: andrew.georgiou@mq.edu.au. 7. La Trobe University, School of Psychology and Public Health, College of Science, Health and Engineering, VIC, 3086, Australia. Electronic address: sophie.hill@latrobe.edu.au. 8. Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC, 3125, Australia. Electronic address: susan.balandin@deakin.edu.au. 9. The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia. Electronic address: shaun.mccarthy@newcastle.edu.au.
Abstract
OBJECTIVE: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. METHOD: An integrative review of 93 studies, analysed according to their content themes. RESULTS: Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. CONCLUSIONS: There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. PRACTICE IMPLICATIONS: It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients' end-of-life care decisions.
OBJECTIVE: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. METHOD: An integrative review of 93 studies, analysed according to their content themes. RESULTS: Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. CONCLUSIONS: There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. PRACTICE IMPLICATIONS: It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients' end-of-life care decisions.
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