TY - JOUR
T1 - Healthcare professionals’ perceptions of advance care planning in palliative care unit
T2 - a qualitative descriptive study
AU - Kuusisto, Anne
AU - Santavirta, Jenni
AU - Saranto, Kaija
AU - Haavisto, Elina
N1 - Funding Information:
In this study, referred to ACP care planning being assessed by professionals to coordinate patient care; for example, professionals knew how to act in a particular situation, which broadened the perspective of ACP from a patient‐centred process or document (Institute of Medicine, 2015 ; Rietjens et al., 2017 ) to a tool for ACP care planning and coordination in patients’ clinical pathway in the service system. In this study, ACP documentation was seen as a shared interprofessional responsibility between physicians and nurses, but surprisingly, social workers did not recognise their role in ACP compared to a previous study (Boddy et al., 2013 ) where social workers had a central role in ACP and were relied on by others for decision‐making. In this study, social workers were perhaps not familiar with the ACP concept and they may have viewed it solely as a patient care plan. This may be due to the fact that there are often few social workers in the units and they may easily be left out of patient care. This gives rise to concern because different professional groups have different responsibilities in patient care and thus also in ACP. A fundamental aspect of social work is attention to environmental forces that address problems in living, for example (National Association of Social Workers 2020 ). Thus, social workers know the service system and the availability of services and they play a key role in, for example preparation for patient discharge. In this study, physicians identified the benefits of structured documentation and the need for further development. Previously, nurses have said that a structured format could provide a guide for ACP and help also patients’ understanding of ACP (Li‐Shan et al., 2015 ). In this study, ACP was seen as streamlining operations and care processes when there was no need to burden other professionals or units when ACP was available. This is an extremely important finding, because the current healthcare environment is characterised by a lack of coordination (Toguri et al., 2020 ). Our finding is supported by previous research. In their study, Shanley et al. ( 2011 ) indicated that if ACP was not available, staff and family might be making decisions without preparation and would likely send the patient from nursing home to hospital. coordination of care activities through ACP
Publisher Copyright:
© 2020 John Wiley & Sons Ltd
PY - 2021/3
Y1 - 2021/3
N2 - Aims and objectives: To describe healthcare professionals’ perceptions of advance care planning (ACP) in palliative care unit in hospital ward or outpatient clinic. Background: Clinical guidelines recommend timely ACP as a central component of patient-centred palliative care. However, the ACP concept and terminology have been judged to be confusing, and practices are not established. Professionals’ views are needed for ACP adoption and usage. Design: Qualitative descriptive design. Methods: The study used purposive sampling. The data were collected through focus group interviews with registered nurses and practical nurses and individual or couple interviews with physicians and social workers. The data (n = 33) were analysed by inductive content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Three main categories emerged: Information content of ACP, coordination of care activities through ACP, and support for patients’ and family members’ coping. The information content of ACP included assessment of need for patient care, preparing for changes in patient's state of health and proactive medication. Coordination of care activities through ACP contained ACP care planning, cooperation and work practices between healthcare professionals. Support for patients’ and family members’ coping included communication between patient, family members and professionals and promoting patient self-care. Conclusions: ACP is a useful and proactive tool for integrating patient-centred information, care and services as well as support for patients’ and family members’ coping. Palliative care activities can be coordinated through ACP in a multidisciplinary manner. ACP is significant and relevant for both professionals’ work and patient care throughout the service system. Relevance to clinical practice: Results highlight the importance of proactive, concrete and holistic ACP. ACP should be up to date to reflect patient's current wishes. Raising professional awareness and implementing ACP into work processes are essential. Results can be utilised in planning and implementing interprofessional in-service training.
AB - Aims and objectives: To describe healthcare professionals’ perceptions of advance care planning (ACP) in palliative care unit in hospital ward or outpatient clinic. Background: Clinical guidelines recommend timely ACP as a central component of patient-centred palliative care. However, the ACP concept and terminology have been judged to be confusing, and practices are not established. Professionals’ views are needed for ACP adoption and usage. Design: Qualitative descriptive design. Methods: The study used purposive sampling. The data were collected through focus group interviews with registered nurses and practical nurses and individual or couple interviews with physicians and social workers. The data (n = 33) were analysed by inductive content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Three main categories emerged: Information content of ACP, coordination of care activities through ACP, and support for patients’ and family members’ coping. The information content of ACP included assessment of need for patient care, preparing for changes in patient's state of health and proactive medication. Coordination of care activities through ACP contained ACP care planning, cooperation and work practices between healthcare professionals. Support for patients’ and family members’ coping included communication between patient, family members and professionals and promoting patient self-care. Conclusions: ACP is a useful and proactive tool for integrating patient-centred information, care and services as well as support for patients’ and family members’ coping. Palliative care activities can be coordinated through ACP in a multidisciplinary manner. ACP is significant and relevant for both professionals’ work and patient care throughout the service system. Relevance to clinical practice: Results highlight the importance of proactive, concrete and holistic ACP. ACP should be up to date to reflect patient's current wishes. Raising professional awareness and implementing ACP into work processes are essential. Results can be utilised in planning and implementing interprofessional in-service training.
KW - Advance care planning
KW - electronic health record
KW - palliative care
KW - professional perspective
KW - qualitative research
U2 - 10.1111/jocn.15578
DO - 10.1111/jocn.15578
M3 - Article
C2 - 33275801
AN - SCOPUS:85097501226
VL - 30
SP - 633
EP - 644
IS - 5-6
ER -