Protecting prisoners' autonomy with advance directives: ethical dilemmas and policy issues

The Use of Advance Directives in Specialized Care Units: A Focus Group Study With Healthcare Professionals in Madrid

Eight focus groups were conducted in four public hospitals in Madrid to explore healthcare professionals' perceptions of advance directives (ADs) in order to improve the understanding of their lack of success among physicians and patients. A purposive sample of sixty healthcare professionals discussed ADs and reasons for their infrequent use. Three main themes were identified: perceptions about their meaning, appraisals of their use in clinical practice, and decision-making about them. Healthcare professionals perceived a lack of clarity about their definition and implementation. There is insufficient awareness of their efficacy in improving the quality of clinical relationships and decision-making, and they are often perceived only as a bureaucratic procedure. Advance directives are not integrated in the clinical practice of Madrid's healthcare specialist services because their application is exceedingly complex, because of insufficient education about them (for both professionals and citizens), and because of lack of procedural clarity. Consequently, healthcare professionals are not aware of how ADs could improve clinical decision-making, of when and for whom their use is appropriate, and of who has responsibility for providing ADs-related information to patients. These circumstances contribute to patients' lack of interest in completing these documents and to physicians' sceptical views about their usefulness.

Advance directives in the provision of care for incarcerated adults: a scoping review protocol

SCOPING REVIEW QUESTION/OBJECTIVE

The objective of this review is to map the available evidence around advance directives in the care of incarcerated adults in terms of what has been undertaken, what outcomes have been reported, and what research gaps exist.The specific areas of investigation will include:Practices, policies or interventions used with incarcerated adults concerning advanced directives.Prisoners' experiences with advanced directives when receiving care.Barriers to establishing and implementing advanced directives.Healthcare providers' experiences with implementing advanced directives while providing care.The specific questions for this scoping review are:What types of research related to advanced directives in the provision of care for incarcerated adults have been conducted and reported?What research gaps exist in this area?

CENTER CONDUCTING THE REVIEW

The Indiana Centre for Evidence-Based Nursing Practice: a Collaborating Centre of the Joanna Briggs Institute.

Do Spanish Hospital Professionals Educate Their Patients About Advance Directives? : A Descriptive Study in a University Hospital in Madrid, Spain

It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives (ADs). The objective of this research was to determine the frequency of hospital-based physicians' and nurses' engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses (77 per cent), chronic diseases (61 per cent), and elderly patients (43 per cent). Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age.