Social workers' perspectives about advance directives: A qualitative study

The study explores medical social workers’ perceptions on the importance of and purpose for documenting Advance Directives (ADs) in the United States and their views of the benefits for engaging patients and families in dialogue about ADs and Advance Care Planning (ACP). We conducted a qualitative study using free-text responses from a survey of 142 social workers who work in the medical field in various in-patient hospital and out-patient medical/healthcare settings. Participants were asked, “What is the purpose of documenting an advance directive?” and “Why do you think advance directives are important?” and “What benefits have you experienced in educating patients about advance directives?” Thematic analysis informed themes about the purpose, importance, and benefits of supporting patients in completing an AD. Four themes emerged: 1) The purpose of documenting an AD, 2) Facilitating communication, 3) Creating a plan involves relationship building, and 4) Having an AD reduces suffering and uncertainty. Social workers have expertise in relationship building which is an essential element of the partnering process with patients and their support systems towards AD completion. Social workers who work in medical settings provide ACP education for patients and families and create interprofessional linkages to support patient care. It is clear that social workers add value to care provision to improve communication and provide assistance towards AD completion. •Social workers have a key role in educating patients and families about advance directives, can provide clarity of decision-making.•Process of facilitating advance care planning conversations supports understanding patients’ values, beliefs, and desires for medical care.•Social-Ecological Model, intrapersonal, interpersonal, organizational interactions, and healthcare systems influence advance care planning.