Palliative Care for the Geriatric Anesthesiologist

Shared Decision-Making

Shared decision-making is not a new concept but has been gaining traction in recent years as a means of engaging patients in their health care choices. Decision aid development is being encouraged in order to further enhance patient discussions with clinicians. As shared decision-making engages the patient's core values and goals, clinicians are better able to guide patients with their health care choices. Shared decision-making results in less utilization of health care resources, engages more patient autonomy, and is being advocated for all patients as value-based care.

An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation, documentation, storage, and implementation

OBJECTIVE

To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability.

METHOD

An integrative review of 93 studies, analysed according to their content themes.

RESULTS

Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life.

CONCLUSIONS

There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions.

PRACTICE IMPLICATIONS

It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients' end-of-life care decisions.