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UBC Theses and Dissertations

An analysis of the complexities of advance care planning implementation : insights gained from a review of the literature Wong, Jennifer Wai Yin


Background: Advance care planning (ACP) is a process for patients and families to engage in discussions around future wishes for health care. It offers a means to increase dialogue about end of life care and has the potential to improve patient outcomes. Despite the benefits demonstrated in literature, there are still many challenges to ACP implementation. This thesis investigated why ACP is so difficult to implement by reflecting on the following stakeholders: patients and families of older adults and individuals living with chronic illnesses, health care providers, and health care organizations. Particular examples are drawn from the context in British Columbia, Canada. Methods: A purposeful search strategy modifying the rapid evidence assessment approach was used to synthesize the literature. Research studies, summary reports, and policy documents were used to build a balanced picture of perspectives for policy makers. Bryant’s (2009) Policy Change Model and critical theoretical perspectives shaped this analysis and highlighted the complexities and ideologies behind public, professional, and organizational sentiment. Findings: The analysis of literature on patient and provider perspectives shows the biomedical dominance in health care culture and the disinclination to discuss end of life issues. A shift is needed where recognition and prioritization of ACP implementation is supported by leaders in health organizations. Organization-wide multi-component ACP efforts combined with goals of care documentation have been shown to be most successful in improving patient outcomes, but organizational commitment to development of processes and policies is necessary. There is opportunity for nursing leadership and research to move ACP efforts forward in organizations. Conclusion: The analysis presented in this thesis maps evidence for policy makers, stakeholders, and nursing leaders interested in promoting strategic ACP implementation and future ACP research. Process and policy changes are needed to support public and provider engagement.

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