Advance directives and the impact of timing. A qualitative study with Swiss general practitioners.

Details

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State: Public
Version: Final published version
Serval ID
serval:BIB_48094D8E75D8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Advance directives and the impact of timing. A qualitative study with Swiss general practitioners.
Journal
Swiss Medical Weekly
Author(s)
Otte I.C., Jung C., Elger B.S., Bally K.
ISSN
1424-3997 (Electronic)
ISSN-L
0036-7672
Publication state
Published
Issued date
2014
Peer-reviewed
Oui
Volume
144
Pages
w14035
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: epublish
Abstract
PRINCIPLES: Advance directives are seen as an important tool for documenting the wishes of patients who are no longer competent to make decisions in regards to their medical care. Due to their nature, approaching the subject of advance directives with a patient can be difficult for both the medical care provider and the patient. This paper focuses on general practitioners' perspectives regarding the timing at which this discussion should take place, as well as the advantages and disadvantages of the different moments.
METHODS: In 2013, 23 semi-structured face-to-face interviews were performed with Swiss general practitioners. Interviews were analysed using qualitative content analysis.
RESULTS: In our sample, 23 general practitioners provided different options that they felt were appropriate moments: either (a) when the patient is still healthy, (b) when illness becomes predominant, or (c) when a patient has been transferred to a long-term care facility. Furthermore, general practitioners reported uncertainty and discomfort regarding initiating the discussion.
CONCLUSION: The distinct approaches, perspectives and rationales show that there is no well-defined or "right" moment. However, participants often associated advance directives with death. This link caused discomfort and uncertainty, which led to hesitation and delay on the part of general practitioners. Therefore we recommend further training on how to professionally initiate a conversation about advance directives. Furthermore, based on our results and experience, we recommend an early approach with healthy patients paired with later regular updates as it seems to be the most effective way to inform patients about their end-of-life care options.
Pubmed
Web of science
Open Access
Yes
Create date
08/12/2014 18:04
Last modification date
20/08/2019 14:54
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