Perceived Outcomes and Barriers of Advance Care Planning from Healthcare Professionals

Background: Advance care planning (ACP) is the process of aligning patient’s values and preferences to their future medical care, especially regarding end-of-life care decisions. ACP is important in promoting patient autonomy and helping patients and their families prepare for end-of-life conversations. Healthcare teams, made up of physicians, nurses, or social workers, carry the responsibility to engage patients into such conversations. ACP is well researched to end in better patient outcomes in end-of-life care and reported as beneficial from patients and physicians, yet little research is done on the outcomes and barriers for all healthcare workers participating in these conversations beyond just physicians.

Methods: This study used an observational, cross-sectional study from a previously used survey, the DECIDE Allied Health and Physician Questionnaire, which was created to measure the outcomes of ACP – willingness, confidence, and participation – and barriers related to those outcomes as professionals. This study used a convenience sample of 18 allied healthcare professionals and 4 physicians in a not-for-profit, faith-based hospital system in West Texas.

Results: Allied healthcare professionals’ sample (N=18) was composed of nurse practitioners (16.7%), nurses (38.9%), and social workers (11.1%). This study found moderate to high mean ratings for ACP outcomes for physicians and allied healthcare professionals. Allied healthcare professional’s highest outcome (M= 5.11) was their willingness to engage in ACP discussions with patients. Physicians’ highest outcome (M=5.08) was their confidence in having ACP conversations. Pair sample t test showed no significant difference between the two groups. The regression analysis showed allied healthcare professionals who perceived higher barriers in their roles had lower confidence in engaging in ACP with patients (p=0.004). Regression analysis was not conducted for the physicians due to the small sample size (N=4). The need for interdisciplinary communication in ACP reported high means (M>5) for each profession to engage and assist in ACP plans with patients.

Discussion and Implications: Allied healthcare professionals are less engaged and less confident in ACP discussions versus physicians. Healthcare professionals need to have opportunities to expand their knowledge and confidence in ACP conversations. Addressing the biggest barriers to allied healthcare professionals can serve to improve the ACP process for patients. Exploring interdisciplinary roles and interventions to ACP could be useful in practicing the best approaches for ACP with patients and families. Policy within agencies need to be re-evaluated to be able to reflect proper education to healthcare professionals on ACP law and regulations regarding patients’ rights to medical decision making. And requiring education on laws and regulations related to ACP can appropriately implement national policy on ACP in hospital systems and can improve confidence in healthcare professionals performing ACP conversations.