The Use of Advance Directives in Specialized Care Units: A Focus Group Study With Healthcare Professionals in Madrid
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ORIGINAL RESEARCH
The Use of Advance Directives in Specialized Care Units: A Focus Group Study With Healthcare Professionals in Madrid Benjamín Herreros & María José Monforte & Julia Molina & María Velasco & Karmele Olaciregui Dague & Emanuele Valenti Received: 8 September 2019 / Accepted: 10 July 2020 # Journal of Bioethical Inquiry Pty Ltd. 2020
Abstract Eight focus groups were conducted in four public hospitals in Madrid to explore healthcare professionals’ perceptions of advance directives (ADs) in order to improve the understanding of their lack of success among physicians and patients. A purposive sample of sixty healthcare professionals discussed ADs and reasons for their infrequent use. Three main themes were identified: perceptions about their meaning, appraisals of their use in clinical practice, and decision-making about them. Healthcare professionals perceived a lack of clarity about their definition and implementation. There is insufficient awareness of their efficacy in
improving the quality of clinical relationships and decision-making, and they are often perceived only as a bureaucratic procedure. Advance directives are not integrated in the clinical practice of Madrid’s healthcare specialist services because their application is exceedingly complex, because of insufficient education about them (for both professionals and citizens), and because of lack of procedural clarity. Consequently, healthcare professionals are not aware of how ADs could improve clinical decision-making, of when and for whom their use is appropriate, and of who has responsibility for providing ADs-related information to patients. These
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11673-020-09991-w) contains supplementary material, which is available to authorized users. B. Herreros (*) Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Calle Budapest 1, Alcorcón, Madrid, Spain e-mail: [email protected] M. J. Monforte Servicio de Medicina Interna, Hospital Quirónsalud San José, Calle de Cartagena, 111, 28002 Madrid, Spain e-mail: [email protected] J. Molina : M. Velasco Unidad de Investigación, Hospital Universitario Fundación Alcorcón, HUFA, Unidad de Investigación, Calle Budapest 1, Alcorcón, Madrid, Spain
J. Molina e-mail: [email protected]
M. Velasco e-mail: [email protected] K. Olaciregui Dague Epileptology Department, University Hospital Bonn, Germany, Building 83, Venusberg-Campus 1, 53113 Bonn, Germany e-mail: [email protected] E. Valenti Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Centre for Ethics in Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Population Health Sciences, Bristol BS2 8BH, UK e-mail: [email protected]
Bioethical Inquiry
circumstances contribute to patients’ lack of interest in completing these documents and to physicians’ sceptical views about their usefulness. Keywords Advance
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