Table 3 Barriers to enacting ACDs (n = 118*)
Strongly agree | Agree | Disagree | Strongly disagree | |
|---|---|---|---|---|
Uncertainty about the currency of the advance care directive (i.e., does it represent the patient’s current values and wishes?) | 20 (17.5%) | 78 (68.4%) | 15 (13.2%) | 1 (0.9%) |
Uncertainty about the legal implications of enacting when a patient’s family or substitute decision maker disagree with the advance care directive | 33 (29.2%) | 64 (56.6%) | 15 (13.3%) | 1 (0.9%) |
Difficulty accessing the advance care directive when treatment decisions need to be made | 41 (36%) | 51 (44.7%) | 19 (16.7%) | 3 (2.6%) |
Poor knowledge among doctors about what constitutes a legally binding advance care directive | 23 (20.4%) | 64 (56.6%) | 24 (21.2%) | 2 (1.8%) |
Poor knowledge among doctors about the circumstances in which an advance care directive should be used | 18 (15.8%) | 48 (42.1%) | 46 (40.4%) | 2 (1.8%) |
Lack of detail and specificity within the advance care directive to meaningfully guide decision making | 24 (21.1%) | 59 (51.8%) | 30 (26.3%) | 1 (0.9%) |
Use of vague language in the advance care directive, which makes it difficult to use it to meaningfully guide decision making | 28 (24.6%) | 45 (39.5%) | 40 (35.1%) | 1 (0.9%) |
Difficulty identifying a patient’s substitute decision maker | 14 (12.3%) | 59 (51.8%) | 40 (35.1%) | 1 (0.9%) |