Cross-Cultural Considerations in Promoting Advance Care Planning ...

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Advanced Care Planning in Canada
it should ideally happen “…before you’re ever diagnosed with any illness. You know ideally it should be a
conversation that families are having as part of, you know, just general life planning”. However, another informant
expressed the view that:
…I think that’s what so unrealistic to ask people to have advance directives, for everybody to have one, you know.
That’s what I find so difficult. You know, I think until you’re faced with an illness and you then know what the
prognosis is, you know, what the probable life expectancy is, and what the options for treatment are, then you can
start to make a decision as to what you want.
3.
Communication was seen as another key problem. Specifically, even when those conversations around ACP occur,
this information is not necessarily transmitted effectively amongst the various health care professionals connected
with the patient in question. As one interviewee noted:
…everybody and their dog can have an advance care directive, but if nobody at the hospital can find it or knows
about it then it doesn’t do you any good… So how do you put that information in the hands of the people that
need to know, when they need to know? And I think that’s as much of the battle as getting people to write them in
the first place.
4.
Resources and training were also found to be a challenge with the effective implementation of ACP. Organizations
must grapple with whom they are going to employ to conduct conversations about ACP and the resource
implications involved. One informant noted that a very good advance care directive takes “at least 30 minutes”.
Others emphasized the need for conversations about ACP to take place with “someone specifically trained to be
able to have that conversation”. As another informant noted: “…there’s such a time constraint, and of course
everybody’s busy”. For those regions where physicians are expected to play a key role in discussing ACP with their
patients, “another [barrier] might be the reimbursement of physicians for the time that it spent – they would have
to spend with helping their patients fill out an advance care plan”.
The following key themes emerged from an
organizational stand point:
1.
The interviews with key organizational figures revealed that
ACP was increasingly being discussed in many palliative care
and hospice organizations. In some cases, ACP policies have
been implemented from above and in other cases they have
emerged out of the experiences and concerns of clinicians.
Although there was regional variation in ACP policies and
practices, the overall consensus amongst the key informants
appeared to be that ACP is important – although there were
a number of concerns about how to integrate it into practice.
In the words of one informant:
Okay, this is a great idea but how do you actually make it
work?
2.
The logistics of locating the ACP document were found
to be challenging. There was mention about the need for
“transferable directives”, pointing out that:
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