Diah Martina1, Cheng-Pei Lin2, Martina S Kristanti3, Wichor M Bramer4, Masanori Mori5, Ida J Korfage6, Agnes van der Heide6, Carin C D van der Rijt7, Judith A C Rietjens6. 1. Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Universitas Indonesia, Indonesia; Cipto Mangunkusumo National Center Hospital, Jakarta, Indonesia. Electronic address: d.martina@erasmusmc.nl. 2. Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom; Institute of Community Health Care, School of Nursing, National Yang-Ming University, Taipei, Taiwan. 3. School of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. 4. Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. 5. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 6. Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. 7. Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Abstract
OBJECTIVE: The value of advance care planning (ACP) for patients with life-limiting illnesses is widely recognized but Asian health care professionals' (HCPs') perspectives on ACP have received little systematic attention. We aim to synthesize evidence regarding Asian HCPs' knowledge of, attitudes toward, and experiences with ACP. DESIGN: Systematic review with narrative synthesis and stepwise thematic analysis. SETTING AND PARTICIPANTS: HCPs in southern, eastern, and southeastern Asia. METHODS: Studies from inception to September 2019 were identified from English-language searches of Embase, MEDLINE, Web of Science, and Google Scholar with reference-chaining and hand-searching. Two investigators independently screened and assessed the risk of bias in all original studies reporting HCPs' knowledge of, attitudes toward, and experiences with ACP, including their perspectives toward barriers and facilitators of ACP. RESULTS: Fifty-one studies were included; 42 were quantitative, 43 had been conducted in high-income countries, and 36 were of good quality. Twenty-six studies operationalized ACP as the completion of an advance directive rather than a value-exploration process. Thirteen studies reported knowledge, 44 attitudes, 29 experiences, and 36 barriers and facilitators of ACP. Asian HCPs addressed the essential role of families in ACP. They acknowledge the importance of ACP but rarely engage the patient in it. They considered ACP difficult to initiate, partly because of their lack of knowledge and skills in ACP, personal uneasiness to conduct ACP, fear of conflicts with family members and their legal consequences, and the lack of a standard system for ACP. Most studies indicated HCPs' low engagement and late initiation of ACP. CONCLUSIONS AND IMPLICATIONS: Despite acknowledging its importance, Asian HCPs felt that engaging in ACP is challenging. Capacity building for ACP in Asia should focus on culturally adapting ACP models concerning the essential role of the family in Asia, education for HCPs and the public, and providing institutional support for ACP.
OBJECTIVE: The value of advance care planning (ACP) for patients with life-limiting illnesses is widely recognized but Asian health care professionals' (HCPs') perspectives on ACP have received little systematic attention. We aim to synthesize evidence regarding Asian HCPs' knowledge of, attitudes toward, and experiences with ACP. DESIGN: Systematic review with narrative synthesis and stepwise thematic analysis. SETTING AND PARTICIPANTS: HCPs in southern, eastern, and southeastern Asia. METHODS: Studies from inception to September 2019 were identified from English-language searches of Embase, MEDLINE, Web of Science, and Google Scholar with reference-chaining and hand-searching. Two investigators independently screened and assessed the risk of bias in all original studies reporting HCPs' knowledge of, attitudes toward, and experiences with ACP, including their perspectives toward barriers and facilitators of ACP. RESULTS: Fifty-one studies were included; 42 were quantitative, 43 had been conducted in high-income countries, and 36 were of good quality. Twenty-six studies operationalized ACP as the completion of an advance directive rather than a value-exploration process. Thirteen studies reported knowledge, 44 attitudes, 29 experiences, and 36 barriers and facilitators of ACP. Asian HCPs addressed the essential role of families in ACP. They acknowledge the importance of ACP but rarely engage the patient in it. They considered ACP difficult to initiate, partly because of their lack of knowledge and skills in ACP, personal uneasiness to conduct ACP, fear of conflicts with family members and their legal consequences, and the lack of a standard system for ACP. Most studies indicated HCPs' low engagement and late initiation of ACP. CONCLUSIONS AND IMPLICATIONS: Despite acknowledging its importance, Asian HCPs felt that engaging in ACP is challenging. Capacity building for ACP in Asia should focus on culturally adapting ACP models concerning the essential role of the family in Asia, education for HCPs and the public, and providing institutional support for ACP.
Authors: Diah Martina; Christina Yeni Kustanti; Rahajeng Dewantari; Noorwati Sutandyo; Rudi Putranto; Hamzah Shatri; Christantie Effendy; Agnes van der Heide; Judith A C Rietjens; Carin van der Rijt Journal: BMC Palliat Care Date: 2022-06-22 Impact factor: 3.113
Authors: Diah Martina; Olaf P Geerse; Cheng-Pei Lin; Martina S Kristanti; Wichor M Bramer; Masanori Mori; Ida J Korfage; Agnes van der Heide; Judith Ac Rietjens; Carin Cd van der Rijt Journal: Palliat Med Date: 2021-09-06 Impact factor: 4.762