Abstract
Advance directives are seen as an important tool for documenting the wishes of patients who are no longer competent to make decisions in regards to their medical care. Due to their nature, approaching the subject of advance directives with a patient can be difficult for both the medical care provider and the patient. This paper focuses on general practitioners' perspectives regarding the timing at which this discussion should take place, as well as the advantages and disadvantages of the different moments. In 2013, 23 semi-structured face-to-face interviews were performed with Swiss general practitioners. Interviews were analysed using qualitative content analysis. In our sample, 23 general practitioners provided different options that they felt were appropriate moments: either (a) when the patient is still healthy, (b) when illness becomes predominant, or (c) when a patient has been transferred to a long-term care facility. Furthermore, general practitioners reported uncertainty and discomfort regarding initiating the discussion. The distinct approaches, perspectives and rationales show that there is no well-defined or "right" moment. However, participants often associated advance directives with death. This link caused discomfort and uncertainty, which led to hesitation and delay on the part of general practitioners. Therefore we recommend further training on how to professionally initiate a conversation about advance directives. Furthermore, based on our results and experience, we recommend an early approach with healthy patients paired with later regular updates as it seems to be the most effective way to inform patients about their end-of-life care options.
Highlights
Advance directives are written documents which give patients the opportunity to outline the treatments that they do or do not wish to receive if a future situation renders them unable to make decisions regarding their medical care [1, 2]
PRINCIPLES: Advance directives are seen as an important tool for documenting the wishes of patients who are no longer competent to make decisions in regards to their medical care
Due to their nature, approaching the subject of advance directives with a patient can be difficult for both the medical care provider and the patient
Summary
Advance directives are written documents which give patients the opportunity to outline the treatments that they do or do not wish to receive if a future situation renders them unable to make decisions regarding their medical care [1, 2] (for an example of an advance directive form see: http://www.fmh.ch/files/pdf11/PV_e_Ausfuehrliche_Version.pdf [last access: March2014]). Advance directives are written documents which give patients the opportunity to outline the treatments that they do or do not wish to receive if a future situation renders them unable to make decisions regarding their medical care [1, 2] Topics of discussion include whether advance directives are valuable tools for assessing personal values [6, 7] and whether or not advance directives can express the will of different patient groups in situations in which communication or competent decision making is no longer possible [8,9,10]. Several qualitative studies have shown that most general practitioners (GPs) appreciate the positive impact that advance directives have on patients, families and health professionals [12,13,14,15].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
