Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies
Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies
Context: Advance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges.
Objective: to investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice.
Design: an explanatory systematic review of qualitative implementation studies.
Data sources: empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched.
Methods: direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes.
Results: 13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations.
Conclusions: this review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows
e0116629
Lund, Susi
239a4d54-13e1-4d69-8e3f-08475c20af47
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
13 February 2015
Lund, Susi
239a4d54-13e1-4d69-8e3f-08475c20af47
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Lund, Susi, Richardson, Alison and May, Carl
(2015)
Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies.
PLoS ONE, 10 (2), .
(doi:10.1371/journal.pone.0116629).
Abstract
Context: Advance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges.
Objective: to investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice.
Design: an explanatory systematic review of qualitative implementation studies.
Data sources: empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched.
Methods: direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes.
Results: 13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations.
Conclusions: this review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows
Text
Lund Barriers to advance care planning ACP Plos one 2015.pdf
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More information
Accepted/In Press date: 11 December 2014
Published date: 13 February 2015
Organisations:
Faculty of Health Sciences
Identifiers
Local EPrints ID: 377341
URI: http://eprints.soton.ac.uk/id/eprint/377341
ISSN: 1932-6203
PURE UUID: 0905f41e-e256-41fc-bc10-ff3907416171
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Date deposited: 29 May 2015 10:54
Last modified: 15 Mar 2024 03:34
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Author:
Susi Lund
Author:
Carl May
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