It’s just too hard! Australian health care practitioner perspectives on barriers to advance care planning
Jennifer Boddy A B D , Lesley Chenoweth A B , Vanette McLennan A B and Michelle Daly A C
+ Author Affiliations
- Author Affiliations
A School of Human Services and Social Work, Griffith University, Parklands Drive, Southport, Qld 4222, Australia.
B Population and Social Health Research Program, Griffith Health Institute, Parklands Drive, Southport, Qld 4222, Australia.
C Queensland Health, Gold Coast Health Service District, 108 Nerang Street, Southport, Qld 4215, Australia.
D Corresponding author. Email: j.boddy@griffith.edu.au
Australian Journal of Primary Health 19(1) 38-45 https://doi.org/10.1071/PY11070
Submitted: 7 July 2011 Accepted: 6 December 2011 Published: 10 January 2012
Abstract
This article presents findings from six focus groups with health care practitioners in an Australian hospital during 2010, which sought to elicit their perspectives on the barriers for people to plan their future health care should they become unwell. Such knowledge is invaluable in overcoming the barriers associated with advance care planning and enhancing the uptake of advance directives and the appointment of an enduring power of attorney for people of all ages. A person’s rights to self-determination in health care, including decision making about their wishes for future care in the event they lose cognitive capacity, should not be overlooked against the backdrop of increasing pressure on health care systems. Findings suggest that multiple barriers exist, from practitioners’ perspectives, which can be divided into three major categories, namely: patient-centred, practitioner-centred and system-centred barriers. Specifically, patient-centred barriers include lack of knowledge, accessibility concerns, the small ‘window of opportunity’ to discuss advance care planning, emotional reactions and avoidance when considering one’s mortality, and demographic influences. At the practitioner level, barriers relate to a lack of knowledge and uncertainty around advance care planning processes. Systemically, legislative barriers (including a lack of a central registry and conflicting state legislation), procedural issues (particularly in relation to assessing cognitive capacity and making decisions ad hoc) and questions about delegation, roles and responsibilities further compound the barriers to advance care planning.
Additional keywords: advance directive, aging, enduring power of attorney, focus groups.
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