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

Discussion
Advanced Care Planning in Canada
DISCUSSION
The purpose of this report was to provide insight about how diverse cultural and Aboriginal groups in Canada
might respond to advance care planning (ACP) becoming a part of the health care system. By talking to key informants
across the country, we were able to determine that ACP is an important and valuable tool that can provide a sense of
control, comfort and peace at the EOL. Despite many ethnic groups not knowing what ACP was, they were open to
learning more about ACP and how they could participate in their EOL decision-making.
Terminology around ACP was confusing and many people use key terms interchangeably. However, it was
clear that whatever one called it, key informants made distinctions regarding the conversation versus the document.
Although the document was important for clarification and legal purposes, the process of being able to have the
conversation about what one would want in the event that they could not make decisions for themselves was seen as
essential from many perspectives:
1.
2.
3.
patients felt that their values and beliefs would be respected;
families said that they did not have to endure any guilt about having done enough or anxiety about doing the right
thing; and,
health care professionals reported that it eased their burden of care giving because they knew what was expected of
them and that the services they provided were what the patients wanted.
There was fear that signing “a document” was equivalent to signing a DNR order and that patients were essentially
consenting to life-limiting treatments without truly understanding what they were signing. Hence, the conversation,
although viewed as unpleasant and perhaps depressing, was seen as a key component to go hand-in-hand with the
document. In addition, there are few health care systems that have a consistent method of accessing advance directives.
Therefore, in the event of not being able to obtain it in a timely manner, having had the conversation with family
members or HCP would be pertinent.
HCP also valued the conversation, however, who would be best to initiate this conversation and ensure that
ongoing conversations continue was not identified. In Canada there are several different palliative care programs in
which a nurse may be responsible; some hospices have volunteers engage in ACP; a few areas have coordinators who
are responsible for overseeing ACP; in hospitals it could be social workers, physicians or ICU nurses; in the community
ACP may not exist. It was not clear who should lead, especially if there were interdisciplinary teams where everyone
was expected to oversee EOL care. However, in primary care, general practitioners were raised as an ideal person to
initiate the ACP conversation.
ACP is not the typical medical service that HCP are used to supplying. In a world where time is of the essence
and tasks need to be completed “yesterday”, the addition of ACP is not a simple request. Although the merits of ACP
may be obvious at first glance, putting ACP into practice and seeing those benefits is a difficult task. Perhaps this is the
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