RT Journal Article
SR Electronic
T1 Influence of clinical context on interpretation and use of an advance care planning policy: a qualitative study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E9
OP E15
DO 10.9778/cmajo.20190100
VO 8
IS 1
A1 Marta Shaw
A1 Shelley Raffin Bouchal
A1 Lauren Hutchison
A1 Reanne Booker
A1 Jayna Holroyd-Leduc
A1 Deborah White
A1 Andrew Grant
A1 Jessica Simon
YR 2020
UL http://www.cmajopen.ca/content/8/1/E9.abstract
AB Background: Advance care planning is a process through which people share their values, goals and preferences regarding future medical treatments with the purpose of aligning care received with patient wishes. The objective of this study was to explore perspectives from patients and clinicians in 4 clinical settings to understand how context influences interpretation and application of advance care planning processes.Methods: This study used a qualitative interpretive descriptive design. Patient and clinician participants were recruited across 4 clinical outpatient settings (cancer, heart failure, renal failure and supportive living) in Calgary and Edmonton. Data were collected between 2014 and 2015 by means of recorded one-on-one semistructured interviews. We analyzed the data using thematic analysis in 2016–2017.Results: Thirty-four patients and 34 clinicians participated in interviews. Themes common to all 4 contexts were lack of shared understanding between patients and clinicians, and a lack of consistent clinical process related to advance care planning. Advance care planning understanding and process varied substantially between contexts. This variation seemed to be driven by differences in perceptions around disease burden and the nature of the physician–patient relationship.Interpretation: Provision of a system-wide policy and procedural framework alone was not found to be sufficient to form a standardized approach to advance care planning, as considerable variability existed in advance care planning process between and within clinical settings. Quality-improvement methods that consider local processes, gaps and barriers can help in developing a consistent, comprehensive process.