ArticleBMJ open2019
Doctors' perspectives on adhering to advance care directives when making medical decisions for patients: an Australian interview study.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed, 53 citations in OpenAlex.
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- Shared Decision-Making on Life-Sustaining Treatment: A Survey of Current Barriers in Practice Among Clinicians Across China.Healthcare (Basel, Switzerland) · 2025Article
- Ethical and Legal Challenges in Caring for Older Adults with Multimorbidities: Best Practices for Nurses.Healthcare (Basel, Switzerland) · 2024Article
- The Potential of Evidence-Based Clinical Intake Tools to Discover or Ground Prevalence of Symptoms Using Real-Life Digital Health Encounters: Retrospective Cohort Study.Journal of medical Internet research · 2024Article
- Oncologists' perspective on advance directives, a French national prospective cross-sectional survey - the ADORE study.BMC medical ethics · 2024Article
- Doctor's Perceptions of the Systemic Influences on Advance Care Plan Application: A Thematic Analysis.Journal of multidisciplinary healthcare · 2024Article
- A Revised Approach to Advance Personal Planning: The Role of Theory in Achieving "The Good Result".Journal of bioethical inquiry · 2023Article
- Better Regulation of End-Of-Life Care: A Call For A Holistic Approach.Journal of bioethical inquiry · 2022Article
- A quantitative study of nurses perception to advance directive in selected private and public secondary healthcare facilities in Ibadan, Nigeria.BMC medical ethics · 2022Article
- Junior Medical Officers' knowledge of advance care directives and substitute decision making for people without decision making capacity: a cross sectional survey.BMC medical ethics · 2022Article
- Junior medical doctors' decision making when using advance care directives to guide treatment for people with dementia: a cross-sectional vignette study.BMC medical ethics · 2022Article
- Views of advance care planning in caregivers of older hospitalised patients following an emergency admission: A qualitative study.Journal of health psychology · 2022Article
- Advance care planning and advance directives: an overview of the main critical issues.Aging clinical and experimental research · 2022Review
- Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators.Health expectations : an international journal of public participation in health care and health policy · 2021Article
- 50 Years of advance care planning: what do we call success?Monash bioethics review · 2021Article
- Association between knowledge and attitudes towards advance directives in emergency services.BMC medical ethics · 2021Article
- Advance Care Plans and the Potentially Conflicting Interests of Bedside Patient Agents: A Thematic Analysis.Journal of multidisciplinary healthcare · 2021Article
- Multidisciplinary Clinicians and the Relational Autonomy of Persons with Neurodegenerative Disorders and an Advance Care Plan: A Thematic Analysis.Journal of multidisciplinary healthcare · 2021Article
- Advance Care Planning (ACP) vs. Advance Serious Illness Preparations and Planning (ASIPP).Healthcare (Basel, Switzerland) · 2020Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveAdvance care planning (ACP) assists people to identify their goals, values and treatment preferences for future care. Ideally, preferences are documented in an advance care directive (ACD) and used by doctors to guide medical decision-making should the patient subsequently lose their decision-making capacity. However, studies demonstrate that ACDs are not always adhered to by doctors in clinical practice. We aim to describe the attitudes and perspectives of doctors regarding ACD adherence and the utility of ACDs in clinical practice.
designFace-to-face semistructured interviews were conducted using three case-based vignettes to explore doctors' decision-making and attitudes towards ACDs. Transcripts were analysed using a thematic analysis.
settingDoctors from a variety of medical specialties and with varying experience levels were recruited from a large tertiary hospital in Melbourne, Australia.
participantsA total of 21 doctors were interviewed, 48% female (10/21). Most (19/21) reported having experience using ACDs.
resultsFour themes were identified: aligning with patient preferences (avoiding unwanted care, prioritising autonomy and anticipating family opposition), advocating best interests (defining futile care, relying on clinical judgement, rejecting unreasonable decisions and disregarding legal consequences), establishing validity (doubting rigour of the decision-making process, questioning patients' ability to understand treatment decisions, distrusting outdated preferences and seeking confirmation) and translating written preferences into practice (contextualising patient preferences, applying subjective terminology and prioritising emergency medical treatment).
conclusionsACDs provide doctors with opportunities to align patient preferences with treatment and uphold patient autonomy. However, doctors experience decisional conflict when attempting to adhere to ACDs in practice, especially when they believe that adhering to the ACD is not in the patients' best interests, or if they doubt the validity of the ACD. Future ACP programmes should consider approaches to improve the validity and applicability of ACDs. In addition, there is a need for ethical and legal education to support doctors' knowledge and confidence in ACP and enacting ACDs.
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