Advance care plans and the potentially conflicting interests of bedside patient agents: a thematic analysis

Craig, Denise P., Ray, Robin, Harvey, Desley, and Shircore, Mandy (2021) Advance care plans and the potentially conflicting interests of bedside patient agents: a thematic analysis. Journal of Multidisciplinary Healthcare, 14. pp. 2087-2100.

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Abstract

Aim: People diagnosed with a neurodegenerative disorder often contend with a threat to independence and control, leading some to complete an advance care plan. Advance care plans are commonly associated with treatment limitations; however, key patient agents (such as doctors, allied health, nurses and family) may instead make temporal, best interests or good medical practice decisions on behalf of the patient. Accordingly, there is a need to better understand ancillary decision-maker’s perspectives, particularly of doctors. Purpose: To explain how the potentially conflicting interests of bedside patient agents operates as a factor which influences doctors’ application of advance care plans of people with a neurodegenerative disorder.

Participants and Methods: Using a constructivist grounded theory informed thematic analysis, 38 semi-structured interviews were conducted with hospital-based doctors, allied health, nurses and family of people with a neurodegenerative disorder who had an advance care plan. Data were inductively analysed using open and focused coding.

Results: Analysis revealed two main themes: dynamics of discerning best interests; and avoiding conflict. Rather than applying advance care plans, doctors largely involved families to attempt best interests decision-making partnerships on patients’ behalf. Bedside agents demonstrated significant intra and interpersonal challenges associated with their roles as patient agents. Doctors appeared protective of families and patients with neurodegenerative disorder.

Conclusion: Although bedside agents value advance care plans, doctors often favour temporal healthcare decisions in consultation with family. We suggest there are limitations to the effectiveness of advance care plans in practice, with application typically only occurring close to death. Despite the intentions of advance care planning, bedside agents may still experience considerable dissonance.

Item ID: 70630
Item Type: Article (Research - C1)
ISSN: 1178-2390
Keywords: Advance directive, Consent, End of life, Hospital doctors, Living will, Patient agency
Copyright Information: 2021 Craig et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms https://www.dovepress.com/terms.php).
Date Deposited: 16 Feb 2022 00:16
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420303 Family care @ 30%
42 HEALTH SCIENCES > 4203 Health services and systems > 420309 Health management @ 40%
42 HEALTH SCIENCES > 4203 Health services and systems > 420316 Palliative care @ 30%
SEO Codes: 20 HEALTH > 2003 Provision of health and support services > 200304 Inpatient hospital care @ 70%
20 HEALTH > 2003 Provision of health and support services > 200309 Palliative care @ 30%
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