Table 5 Studies on ADs with health professionals
Field | Year | Author and type of study | Results |
|---|---|---|---|
Primary care (doctors) | 2007 | Santos, Carmen Observational | 169 participants. 97% considered the living will useful, though 83.2% reported not having enough information to help their patients prepare it. 95.2% agreed to address the issue of living wills, but only at the patient’s request, 72.1% in the event of chronic illness and 57.2% systematically during doctor’s visits. The main difficulties identified by doctors in the formalization of ADs were: 84.9% found legal problems between the patient’s request and the current legislation, and 80.1% discrepancies between patients’ instructions and those given by their relatives. Doctors’ information sources: 66.3% from non-health related media and 59.2% from the medical press. Most were unaware of current laws and did not how to access the registered document |
Primary care (doctors) | 2011 | Navarro, Beatriz Qualitative study | 13 participants. Overall, there was a positive attitude towards ADs, but also great ignorance about the document and its purpose. Lack of time was one of the impediments to implementing ADs during doctor’s visits. Alternatives to primary care visits are proposed to improve implementation. There is a need to include the document in the patient’s medical record. The reasons for which ADs have not been further developed are misinformation and culture (death is still perceived as a taboo). Any initiative on ADs must be made by the patient |
Primary care (doctors and nurses) | 2009 | Valle, A Observational | 113 participants. 68.1% were aware of the possibility of registering ADs. 70% believed that the initiative to talk about ADs had to be made by patients themselves. 53.2% considered the primary care visit to be the appropriate environment for addressing ADs. 60.7% would feel comfortable addressing the issue. The main difficulties in addressing it were: talking about death with patients (52.2%) and explaining administrative procedures (45.1%). 55.4% believed that the population would be interested in completing ADs |
Primary care (doctors, nurses, assistants, social workers) | 2010 | Champer, Anna Observational | 227 participants. 83.8% knew the definition of ADs. Only 4.1% knew about their legal aspects, 0.5% the registration procedure, 1.4% the document content and 38.6% the document’s purpose. Only 4 professionals out of 277 had prepared ADs |
Primary care (doctors, nurses, social workers) | 2015 | Fajardo, MC Observational | 340 participants. 78.4% believed that ADs were regulated by law. 33.9% of doctors, 36.4% of nurses, and 100% of social workers had read the document. Those surveyed were willing to prepare their own ADs and to use them, were aware of their utility and wanted them to be respected by health professionals |
Primary care (doctors, nurses) | 2015 | Jiménez, José M Observational | 85 participants. 95.3% knew that ADs were regulated by law, 40% had read them at some time, and 37.6% were familiar with the provincial AD Register. 24.7% had read the guide on ACP, and 12.9% had made plans in advance with patients about their final wishes during a doctor’s visit. Few professionals were truly knowledgable about the document, but it was considered a useful tool for clinical practice, requiring better training for professionals, and increased dissemination and awareness among the healthy population |
Primary and specialized care (doctors and nurses) | 2008 | Simón Lorda, Pablo Observational | 298 nurses: 63.1% knew that ADs were regulated by law, and 32.3% had read an AD document at some time. Most believed that it was advisable to plan and prepare the patient’s wishes regarding health care, considering ADs to be a useful tool for professionals and relatives. High willingness to complete ADs, though not in the very near future, was found |
Simón Lorda, Pablo Observational | 194 doctors. 69.6% knew that ADs were regulated by law, and 37.6% had read an AD document at some time. Most believed that it was advisable to plan and prepare the patient’s wishes regarding health care, considering ADs to be a useful tool for professionals and relatives. High willingness to complete ADs, though not in the very near future, was found | ||
2013 | Toro, Rafael Observational | 192 participants. 60.1% knew about the legal regulation of ADs, above all primary care doctors and nurses. 22.8% had read ADs. A favorable attitude was found towards the use of, utility of and respect for ADs content. Primary care doctors and hospitalization nurses showed a more favorable attitude towards ACP than did hospital doctors and primary care nurses | |
Primary care and specialists (doctors) | 2013 | Ameneiros-Lago, Eugenia Observational | 120 participants. 17.5% had detailed knowledge of ADs, with specialist doctors showing the best knowledge, and more than 10 years experience. 23.3% had at some point explained the advisability of preparing ADs to patients, with 6.7% helping them do so. 90.8% showed a positive attitude towards their usefulness and 87.9% would be willing to complete ADs |
Primary care and specialists | 2018 | Martínez, ML Observational | 431 participants. Lack of knowledge about both ADs and advanced decision planning. 4.6% had ADs, and 42% were unaware of regional regulation. Positive attitude towards the usefulness of the documents and considered it convenient to plan care with patients |
Primary care and specialists (doctors and nurses) | 2018 | Aguilar, Juan M Observational | 329 participants. Low level of knowledge, especially about document content, legal aspects and procedure. 18.5% had had experience handling them, and 22.2% had read an AD at some time. 94.5% would participate in training activities, showing a very positive attitude towards the document |
Specialized care (doctors and nurses) | 2011 | Franco Tovar, Begoña Observational | 607 participants. Only at one hospital out of eight was there a valid ADs protocol. 12% indicated that the preferences of terminally-ill patients were explored in their ward, especially in the ICU |
Specialized care (doctors and nurses) | 2014 | Sepúlveda, Juana M Qualitative study | 17 participants. Professionals felt uncomfortable asking and informing about ADs, although they considered it very important for the patient’s wishes to be respected. Nurses stated they had greater difficulty accessing the ADs register and content. They expressed the need to further both undergraduate and graduate training on how to approach terminal patients |
Specialized care (doctors, nurses, assistants) | 2016 | Pérez, María Observational | 283 participants. 84% never informed their patients about ADs. Reasons: 33.9% did not consider it a part of their job, 21.2% claimed they do not have enough time, and 18.3% did not know what ADs were. The patient profile they believed should receive information was: 77% terminally-ill patients, 61% chronically-ill patients and 43% the elderly. Regarding who should provide that information, 62.6% considered the primary care doctor to be the key player. 57% knew what ADs were, 19% how to complete them and 16% their legal regulation. 83% considered patient involvement in ADs completion to be important. 79% expressed their desire to complete ADs. The degree of knowledge was higher among the medical services compared with surgical services, and doctors compared with nurses |
Specialized care (doctors, nurses) | 2020 | Herreros, Benjamín Qualitative study | 60 participants. Many professionals considered ADs to be a bureaucratic procedure with no real impact on the quality of clinical practice. They showed a lack of professional awareness about the utility of ADs. They also considered it a complex procedure, causing it to be non-user friendly and hindering use. The information received by professionals on ADs was inadequate, and there were professionals who, having received training on ADs, did not use them |
Specialized care (nurses) | 2020 | Vázquez, Miriam Observational | 262 participants. 2% felt that they had enough information, 50% believed that professionals are required to provide information on ADs, and 13% said that patients are not well informed. From 61 to 93% fail to answer questions related to documentation, use and legal issues. 84% believe that respecting patients’ values and beliefs is mandatory and 89% that patients had the right to decide about care. Most would recommend that their chronic patients prepare such a document |
Emergencies and ICU (doctors) | 2010 | Nebot, Cristina Observational | 84 participants. 6% had consulted the ADs Register. Reasons for not consulting the register: 28% stated that they did not have a password or know how to consult it |
Emergencies (doctors and nurses) | 2007 | Mateos, Alonso A Observational | 49 participants. 73.5% claimed to be familiar with ADs and 18% with the current legislation on ADs. 51% had at some time asked whether anyone knew the patient’s preferences before beginning CPR maneuvers. 83.3% were willing to complete ADs, though none had done so |
2015 | Dorribo, Marta Observational | 71 participants. 85.9% knew what ADs were, 39.4% had at some time read ADs, but most did not know whether an Autonomous Community law governed them. 40.8% indicated that they can be consulted through the medical records. 84.5% knew that ADs foresee limits on medical action. The vast majority were unaware that the person’s values may also be reflected. 56.3% had not considered the possibility that a terminally ill patient had prepared ADs. Most considered them to be a useful document for patients’ relatives. None had prepared ADs, but 16.9% considered the possibility of doing so in the next year. Factors influencing poor implementation: patients’ biases towards these issues and little information from professionals | |
Intensive Care (doctors and nurses) | 2016 | Velasco, Tayra Observational | 331 participants. 90.25% were unaware of the steps foreseen in ADs. 90.6% did not know whether the patients in their care had ADs. 50.2% indicated that ADs were not honored when required. 82.8% considered them to be a useful tool for professionals in decision-making |
Residences (doctors, nurses, nurse aids, social worker, occupational therapist) | 2017 | Sánchez, María R Qualitative study | 15 participants. Difficulties in communication with families, related to feelings of guilt, difficulty in understanding deterioration and approaching the subject of death late in the process. Other difficulties found were a lack of training, resources and coordination among the various professionals. They did not encourage patient participation in decision-making. They considered ADs a necessary tool, though they did not foresee their implementation in a systematic way |
Mental Health (doctors, nurses, nurse aids, psychologists) | 2019 | Juliá-Sanchis, Rocío Qualitative study | 11 participants. Importance of ADs in mental health. Preparing ADs on treatment preferences is an important opportunity for people with mental illness, in the event of hospitalization or temporary disabling events because, among other problems, it can help prevent conflict for family members and professionals. Some of the difficulties in ADs implementation included a lack of knowledge and barriers to their practical management, the fallacy of empowerment with latent paternalism, a paradoxical view of the role played by families, stigma … the importance of developing professional skills to implement ADs in mental health, determining who, what, where and how to address the issue |