Perceived Barriers to Discussing End of Life Care Planning

Abstract

Advance care planning (ACP) related to end of life (EOL) care is an often neglected area in primary care. Nurse care managers (NCM’s) are in a unique position to initiate earlier conversations about illness management and patient preferences regarding end of life so patients have the opportunity to make choices and have their wish known while they are still cognitively independent. The purpose of this quality improvement project was to identify barriers to discussions about end of life care with patients in clinical practice. Six NCM’s participated in two focus groups to identify perceived barriers for end of life care discussions and to identify potential solutions to those barriers. Barriers identified included: patient/family factors, organizational factors, and provider related factors. NCM solutions identified included patient related interventions such as normalizing and routinizing EOL/ACP discussion reviewing choices at all ages annually. Organizational solutions recommended include making EOL care discussions a quality measure and training all office staff to support culture change. Provider related recommendations included providers completing their own advance directive as a way to lead the way for patients. Implications for education, practice, policy, and research are identified. Acknowledgements I would like to thank my family for all the support and time needed to fulfill this great career achievement. I look forward to new beginnings and regaining that time back to spend with them on future adventures. I would also like to thank my academic advisor Dr. Joanne Costello for her continued support and encouragement throughout this process. I would also like to thank my first reader Dr. Carolyn Wood for her guidance in bringing this major project to completion. I would also like to express gratitude to the Nurse Care Managers who participated in the focus groups for their dedication to improving patient outcomes and quality of life. A special thank you to my clinical preceptor and third reader Therese Rochon FNP-C, APRN, who has been there through this entire clinical process, for sharing her advocacy and passion regarding advance care planning and palliative care to give meaning to the end of life process.