4.7 Article

Front-Line Hospice Staff Perceptions of Barriers and Opportunities to Discussing Advance Care Planning With Hospice Patients and Their Families

Journal

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jamda.2021.07.014

Keywords

Advance care planning; qualitative research; health workforce; behavior change; implementation

Funding

  1. National Institute of Nursing Research
  2. National Institute on Aging, National Institutes of Health [K23AG062613, K01AG059831, K24AG054415]
  3. VA Office of Academic Affiliations [AF-3Q-09-2019-C]
  4. UCSF Claude D. Pepper Older Americans Independence Center - National Institute on Aging [P30 AG044281]

Ask authors/readers for more resources

This study aims to understand the facilitators and barriers to hospice staff engagement in advance care planning conversations. Through interviews and analysis, it was found that hospice staff have varying levels of capability, opportunity, motivation, and behavior. Recommendations were made to improve ACP discussions, including training, introducing ACP earlier, and increasing workforce diversity.
Objectives: To understand the facilitators and barriers to hospice staff engagement of patients and surrogates in advance care planning (ACP) conversations. Design: Qualitative study conducted with purposive sampling and semistructured interviews using ATLAS.ti software to assist with template analysis. Settings and Participants: Participants included 51 hospice professionals (31 clinicians, 13 leaders, and 7 quality improvement administrators) from 4 geographically distinct nonprofit US hospices serving more than 2700 people. Measures: Interview domains were derived from the implementation science framework of Capability, Opportunity, Motivation, and Behavior (COM-B), with additional questions soliciting recommendations for behavior change. Differences in themes were reconciled by consensus. The facilitator, barrier, and recommendation themes were organized within the COM-B framework. Results: Capability was facilitated by interdisciplinary teamwork and specified clinical staff roles and inhibited by lack of self-perceived skill in engaging in ACP conversations. Opportunities for ACP occurred during admission to hospice, acute changes, or deterioration in patient condition. Opportunity-related environmental barriers included time constraints such as short patient stay in hospice and workload expectations that prevented clinicians from spending more time with patients and families. Motivation to discuss ACP was facilitated by the employee's goal of providing personalized, patient-centered care. Implicit assumptions about patient's and familie's preferences reduced staff's motivation to engage in ACP. Hospice staff made recommendations to improve ACP discussions, including training and modeling practice sessions, earlier introduction of ACP concepts by clinicians in prehospice settings, and increasing workforce diversity to reflect the patient populations the organizations want to reach and cultural competency. Conclusions and Implications: Even hospice staff can be uncomfortable discussing death and dying. Yet staff were able to identify what worked well. Solutions to increase behavior of ACP engagement included staff training and modeling practice sessions, introducing ACP prior to hospice, and increasing workforce diversity to improve cultural competency. Published by Elsevier Inc. on behalf of AMDA -The Society for Post-Acute and Long-Term Care Medicine.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.7
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available