A Qualitative Study Of Healthcare Staffs’ Attitudes About Implementing Advance Care Planning In Patients With End-stage

Objective:This study aimed to understand healthcare staffs’ attitudes about implementing advance care planning(ACP) in patients with end-stage in Zhejiang province China, to identify the main obstacle factors influencing the implementation of ACP, to puts forward some targeted suggestions through the interviews of medical staffs and to be reference for the implementation of ACP in the clinical practice in China in the future.Methods:Phenomenological research. Healthcare staffs who have high contact frequency with end-stage patients in different hospitals and different districts in Zhejiang Province were purposively recruited and semi-structed interviewed.Record pen was used to record the whole conversation. Interviewees manners, expression changes, tones and talk speeds were also observed and recorded.The recording materials were then translated literally into text materials,double-checked.Colaizzi Analyzing method was used to analyze the text materials.Results:Between Sepetember 2014 and December 2014,17 participants were interviewed. Only 3 participants interviewed had heard of ACP,while the others never heard it before. After repeated reading, analyzed,reflected,classified and refined on the interview data, it comed the final three results and nine subjects,listed below:1. Medical staffs attitudes to informed consent of patients with end-stage: ①Should inform patient:Patient’s rights;Dignity needs,②Sould not be directly informed patient himself:May increased the patient’s psychological burden;May deprive patients hope;Worried about the misunderstanding;Because the state of the union;③In principle should inform patients, the actual operation is different from person to person: Patient’s cultural level, personality, awareness of the disease, etc; Opinions of the family members, etc.2. Medical staffs’attitudes to patient’s need of CPR/endotracheal intubation in end-stage:①Thought don’t need to, but would respect the decision:No practical meaning;Increase patient’s unnecessary pain;Increase the economic burden;No dignity; Waste of medical resources;②There is a need:Life is precious;The rule of law.3. Medical staffs attitudes of the feasibility of ACP:①Feasible:Safeguard the rights and dignity of the patient;Reduced patient’s unnecessary pain;Eased family burden;Saved medical insurances, reduced waste of medical resources;Human civilization development needs.②Infeasible:Worried about medical disputes;Patient adhered to rescue;③Barriers needed to be thought when implemented ACP:Social culture background;Lack of legal support;Difficulties of time choosen;Lack of communication skills and human resource;Hospital hesitation.④Could be implemented but needed certain countermeasures:Strengthen publicity and education, tried to begin with the small population;Legislation support.Conclusion:Medical staff thought it was feasible to implement ACP in patients with end-stage, but barriers needed to be considerated during the concrete implementation, such as social cultural background factors, the lack of legislation, the difficulty of the timing, communication skills and the lack of human resource, hospital hesitatation, and so on.ACP could be tried to implement but needed a certain advices such as strengthening publicity and education, trying to begin with the small populationand legislative support and so on.