As part of ongoing efforts to improve end-of-life care planning, Frances R. Nedjat-Haiem, an associate professor in the College of Health and Social Services at New Mexico State University, conducted a nationwide study to examine health-care providers’ knowledge, attitudes, behaviors and barriers toward educating patients on advance directives.
Nedjat-Haiem, a faculty member in NMSU’s School of Social Work, surveyed 520 health-care providers, including physicians, nurses, social workers and chaplains, through an online questionnaire and found that 86 percent described themselves as “very knowledgeable” about advance directives – a legal document that guides medical decision-making for seriously ill patients, their families and health-care providers – according to her study, which has been accepted for publication in the American Journal of Hospice and Palliative Medicine.
Nearly all of the providers, about 99 percent, “felt it was important” to educate patients on advance directives and ask patients if they had completed one. About 95 percent of the providers said they “experienced benefits” as a result of educating patients about advance directives, while factors such as provider uncertainty, organizational barriers and patients’ approach influenced whether providers would educate their patients.
Advance directives are part of a health initiative known as advance-care planning, which emerged in the 1970s to guide patients and providers in engaging in health-care discussions. The goal is to assist seriously ill patients in documenting advance directives with informed medical decisions before they’re unable to do so.
But advance-directive education is facing challenges. Research shows that certain barriers between patients and providers have led to poor delivery of health-care information, a growing concern that may negatively impact advance-directive education.
“We know there’s a problem and an information gap,” said Nedjat-Haiem, who has devoted her career efforts to researching ways in which to improve end-of-life care for patients and providers. “What I’ve seen in my research is that certain cultures have high respect for their health-care providers, and therefore patients may not ask questions or challenge what they have to say. It comes from a good place – respect – but it is a barrier,” she added, because patients may not get the information they need.
Her latest study found that providers who identified as black or Hispanic were less likely to engage with patients about advance directives, a finding that may suggest a “lack of receptivity” toward advance directives among patients as well as providers. The study also cites evidence suggesting that black and Hispanic patients are less likely to document advance directives, pointing to their faith or religion as an “important guide” for end-of-life decision-making.
Nedjat-Haiem also discovered several “missed opportunities” in provider-patient communication. These included the lack of skills from providers to initiate advance-directive discussions; provider discomfort in discussing advance directives; and concern for patients that they might become emotionally upset while being educated. It is not clear why providers had such largely positive attitudes toward advance-directive education but also held concerns that such discussions could overwhelm or upset patients, according to the study.
Nedjat-Haiem’s findings suggest that having a positive attitude toward advance-directive education and eliminating organization barriers – such as limited time and resources – could improve the likelihood that providers hold end-of-life care discussions with their patients.
Among other barriers, Nedjat-Haiem found a lack of interdisciplinary collaboration among providers. This included confusion about role responsibility, lack of coordinated care and missed opportunities. In the study, she writes that “meaningful communication, strong leadership, and appreciation of various professional roles” can influence care coordination and lead to effective discussions on advance directives.
Next, Nedjat-Haiem said she hopes to secure funding to conduct additional research that would examine cultural adaption of advance-care planning counseling intervention developed specifically for Latinos with advanced chronic illness and their family caregivers in the Southwest region. She also wants to get funding for health literacy to improve advance-care planning communication among older, Spanish-speaking Latinos in the Las Cruces community.
“While chronically ill individuals are living with the possibility of dying, their providers have opportunities to improve patient care by carefully engaging in advance care planning communication, listening to patients’ stories and documenting an advance directive for their future,” she said.
For more information about Nedjat-Haiem’s research, visit https://tinyurl.com/ACPcommunicationNewMexico.
Information from NMSU