Interprofessional Advance Care Planning to Enhance End-of-Life Care: A Community Assessment

Abstract

Background/Purpose: Lawyers and financial planners are more often sought for estate directives than primary care providers for end-of life planning. Lack of role clarity and divergent views about advance care planning (ACP) responsibility among healthcare providers lead to further delay of these important discussions. A comprehensive, interprofessional approach to ACP addressing medical and non-medical decision-making for aging adults is needed. However, few studies have employed an interprofessional ACP approach and none include non-health professionals. The overall purpose of this project was to advance understanding of the unique role of interdisciplinary team members in ACP conversations that promote goal-aligned palliative and end-of-life care. A community-engaged approach was used to address the first aim of the project and identify the need and priorities of community agencies and consumers related to palliative care and ACP understanding.

Methods: A qualitative, exploratory design was employed to investigate ACP understanding, barriers, and needs among aging Nebraskans and Omaha-metro community agencies that serve these consumers. Focus groups were facilitated using open-ended questions to explore participants’ experiences and values related to ACP. Transcripts were analyzed to determine common perspectives, needs, and priorities.

Results:  Three agency focus groups representing five different agencies and five different professional roles and four consumer focus groups representing faith-based communities, public housing, and aging services were conducted.  Three major themes were identified during the analysis: (a) promoting positive outcome, (b) identifying barriers, and (c) anticipating solutions and partnerships. Major themes were refined and defined with subthemes, definitions, and key words.

Conclusions: Improved ACP discussions are needed for supporting value-aligned end-of-life care by educating aging adults about, and documenting their wishes for, life-sustaining treatments and other decisions surrounding death. Enhanced role clarity, increased competence, and a collaborative approach are needed among interprofessional team members involved to improve these end-of-life discussions.