Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals
Asia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The p...
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| Veröffentlicht in: | Palliative & supportive care 2020-08, Vol.18 (4), p.425-430 |
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| creator | Dutta, Oindrila Lall, Priya Patinadan, Paul Victor Car, Josip Low, Chan Kee Tan, Woan Shin Ho, Andy Hau Yan |
| description | Asia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients' autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled.
Guided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals' attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis.
The extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices.
Healthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. Sensitivity towards such cross-cultural practices is key to enhancing ACP awareness, discourse, and acceptability in Asian communities. |
| doi_str_mv | 10.1017/S1478951519000865 |
| format | Article |
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Guided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals' attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis.
The extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices.
Healthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. Sensitivity towards such cross-cultural practices is key to enhancing ACP awareness, discourse, and acceptability in Asian communities.</description><identifier>ISSN: 1478-9515</identifier><identifier>EISSN: 1478-9523</identifier><identifier>DOI: 10.1017/S1478951519000865</identifier><identifier>PMID: 31699170</identifier><language>eng</language><publisher>New York, USA: Cambridge University Press</publisher><subject>Advance directives ; Clinical decision making ; Data analysis ; Decision making ; Focus groups ; Health care ; Hospitals ; Medical personnel ; Minority & ethnic groups ; Nurses ; Original Article ; Palliative care ; Patient-centered care ; Physicians ; Qualitative research ; Semantics</subject><ispartof>Palliative & supportive care, 2020-08, Vol.18 (4), p.425-430</ispartof><rights>Copyright © Cambridge University Press 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c373t-f5a5f12d5be430f99780b4dde060e0c9b2c9473aeba74ed54eba8b8d52fb3aae3</citedby><cites>FETCH-LOGICAL-c373t-f5a5f12d5be430f99780b4dde060e0c9b2c9473aeba74ed54eba8b8d52fb3aae3</cites><orcidid>0000-0003-0373-7043 ; 0000-0001-8969-371X ; 0000-0003-1055-0412 ; 0000-0002-2925-2477 ; 0000-0003-0912-6673 ; 0000-0002-5313-4278</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S1478951519000865/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,780,784,27924,27925,55628</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31699170$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dutta, Oindrila</creatorcontrib><creatorcontrib>Lall, Priya</creatorcontrib><creatorcontrib>Patinadan, Paul Victor</creatorcontrib><creatorcontrib>Car, Josip</creatorcontrib><creatorcontrib>Low, Chan Kee</creatorcontrib><creatorcontrib>Tan, Woan Shin</creatorcontrib><creatorcontrib>Ho, Andy Hau Yan</creatorcontrib><title>Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals</title><title>Palliative & supportive care</title><addtitle>Pall Supp Care</addtitle><description>Asia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients' autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled.
Guided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals' attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis.
The extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices.
Healthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. 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However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients' autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled.
Guided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals' attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis.
The extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices.
Healthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. Sensitivity towards such cross-cultural practices is key to enhancing ACP awareness, discourse, and acceptability in Asian communities.</abstract><cop>New York, USA</cop><pub>Cambridge University Press</pub><pmid>31699170</pmid><doi>10.1017/S1478951519000865</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-0373-7043</orcidid><orcidid>https://orcid.org/0000-0001-8969-371X</orcidid><orcidid>https://orcid.org/0000-0003-1055-0412</orcidid><orcidid>https://orcid.org/0000-0002-2925-2477</orcidid><orcidid>https://orcid.org/0000-0003-0912-6673</orcidid><orcidid>https://orcid.org/0000-0002-5313-4278</orcidid></addata></record> |
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| subjects | Advance directives Clinical decision making Data analysis Decision making Focus groups Health care Hospitals Medical personnel Minority & ethnic groups Nurses Original Article Palliative care Patient-centered care Physicians Qualitative research Semantics |
| title | Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals |
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