Abstract
Advance directives are an under-utilized and under-discussed tool to guide practitioners in caring for patients who are unable to advocate for themselves. Advance directives are traditionally established during a patient encounter with a primary care provider. Information regarding advanced directives must be disseminated and documented at the time of hospital admission, yet meaningful conversations regarding these directives are lacking across the inpatient encounter. Understanding barriers to engaging in conversations regarding advance directives during the inpatient experience will help to facilitate more fluid communication across the health care continuum. This will ultimately reduce the misappropriation of healthcare resources and protect patients’ wishes regardless of phase of care. A qualitative study consisting of semi-structured interviews was conducted to explore inpatient provider barriers to engaging in conversations regarding AD. While the majority (7 out of 9) providers described a routine practice of initiating conversations regarding AD, all participants identified significant barriers. Three themes emerged from the analysis: (1) Effective establishment and utilization of AD requires a collaborative approach, (2) Inpatient conversations regarding AD should be a priority in care, and (3) Provider education and on-going training should be implemented to support providers in this practice. Further research is needed to understand the specialty and setting-specific barriers to meaningful conversations regarding AD.|Keywords: advance; directives; communication; conversations; inpatient