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An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation, documentation, storage, and implementation.
Patient Educ Couns. 2019 06; 102(6):1067-1079.PE

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.

Authors+Show Affiliations

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.The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia. Electronic address: jacqueline.meredith@newcastle.edu.au.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.Western Sydney University, Building G10/Office 10, Hawkesbury Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia. Electronic address: N.Wilson@westernsydney.edu.au.The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia. Electronic address: isabel.higgins@newcastle.edu.au.Macquarie University, Room L6 36, Level 6, 75 Talavera Road, NSW, 2109, Australia. Electronic address: andrew.georgiou@mq.edu.au.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.Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC, 3125, Australia. Electronic address: susan.balandin@deakin.edu.au.The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia. Electronic address: shaun.mccarthy@newcastle.edu.au.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

30799141

Citation

Hemsley, Bronwyn, et al. "An Integrative Review of Stakeholder Views On Advance Care Directives (ACD): Barriers and Facilitators to Initiation, Documentation, Storage, and Implementation." Patient Education and Counseling, vol. 102, no. 6, 2019, pp. 1067-1079.
Hemsley B, Meredith J, Bryant L, et al. An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation, documentation, storage, and implementation. Patient Educ Couns. 2019;102(6):1067-1079.
Hemsley, B., Meredith, J., Bryant, L., Wilson, N. J., Higgins, I., Georgiou, A., Hill, S., Balandin, S., & McCarthy, S. (2019). An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation, documentation, storage, and implementation. Patient Education and Counseling, 102(6), 1067-1079. https://doi.org/10.1016/j.pec.2019.01.007
Hemsley B, et al. An Integrative Review of Stakeholder Views On Advance Care Directives (ACD): Barriers and Facilitators to Initiation, Documentation, Storage, and Implementation. Patient Educ Couns. 2019;102(6):1067-1079. PubMed PMID: 30799141.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation, documentation, storage, and implementation. AU - Hemsley,Bronwyn, AU - Meredith,Jacqueline, AU - Bryant,Lucy, AU - Wilson,Nathan J, AU - Higgins,Isabel, AU - Georgiou,Andrew, AU - Hill,Sophie, AU - Balandin,Susan, AU - McCarthy,Shaun, Y1 - 2019/01/11/ PY - 2018/09/28/received PY - 2018/12/05/revised PY - 2019/01/10/accepted PY - 2019/2/26/pubmed PY - 2020/2/19/medline PY - 2019/2/26/entrez KW - Advance Care Directive KW - Advance care planning KW - End-of-life care KW - Patient views SP - 1067 EP - 1079 JF - Patient education and counseling JO - Patient Educ Couns VL - 102 IS - 6 N2 - 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. SN - 1873-5134 UR - https://www.unboundmedicine.com/medline/citation/30799141/An_integrative_review_of_stakeholder_views_on_Advance_Care_Directives__ACD_:_Barriers_and_facilitators_to_initiation_documentation_storage_and_implementation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0738-3991(18)30810-3 DB - PRIME DP - Unbound Medicine ER -