Abstract
An Advance Care Plan (ACP) is a process of decision-making concerning end of life care that embodies a patient’s values and wishes, for a time when patients are unable to make such decisions for themselves. ACPs have been employed into medical practices worldwide; however, they remain largely uncompleted by general practitioners (GPs), regardless of their benefits to patients and their families with respect to end of life (EOL) care. Furthermore, ACPs will soon be implemented into clinician practices across Ireland, as part of the Assisted Decision Making (Capacity) Act 2015. This review aims to explore the literature to examine challenges GPs may face in employing ACPs into clinical practice. An electronic search was performed through three databases: PubMed, MEDLINE, and CINAHL Plus, through which a total of eleven studies met the selection criteria. Additionally, three studies were provided by experts in the field. Thus, a total of fourteen studies were condensed and critically appraised through CASP (Critical Appraisal Skills Program), which concluded that the quality of the studies was high. Through this review, knowledge gaps and barriers for GPs regarding ACPs were identified. Barriers for implementing ACPs into practice were categorized into three major themes: barriers for the GP, barriers in the healthcare system, and barriers regarding the patient. These included insufficient time, complexity of the ACP documents themselves, uncertainty of the disease prognosis, and the ultimate fear of inducing anxiety and loss of hope in patients.
Highlights
The average life expectancy has increased as technology and medical breakthroughs continue to improve
Themes Current Knowledge of general practitioners (GPs) regarding Advance Care Plan (ACP) This review found that the current understanding of GPs concerning ACPs is inadequate
Some studies found that involving other health professionals facilitated end of life (EOL) discussions, as they specified treatments available that GPs may be unaware of.[2,24]
Summary
The average life expectancy has increased as technology and medical breakthroughs continue to improve. An Advance Care Plan (ACP) provides instructions on healthcare procedures that a person may choose when they no longer have the capacity to do so.[1,2] It can be made freely by patients
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