Schichtel, Markus, Wee, Bee, MacArtney, John I. and Collins, Sarah (2022) Clinician barriers and facilitators to heart failure advance care plans : a systematic literature review and qualitative evidence synthesis. BMJ Supportive & Palliative Care, 12 . e3. doi:10.1136/bmjspcare-2018-001747 ISSN 2045-435X.

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Abstract

Background Clinicians hesitate to engage with advance care planning (ACP) in heart failure. We aimed to identify the disease-specific barriers and facilitators for clinicians to engage with ACP.

Methods We searched Medline, Embase, CINAHL, PubMed, Scopus, the British Nursing Index, the Cochrane Library, the EPOC register, ERIC, PsycINFO, the Science Citation Index and the Grey Literature from inception to July 2018. We conducted the review according to Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two reviewers independently assessed original and empirical studies according to Critical Appraisal Skills Programme criteria. The SURE framework and thematic analysis were used to identify barriers and facilitators.

Results Of 2308 articles screened, we reviewed the full text of 42 studies. Seventeen studies were included. The main barriers were lack of disease-specific knowledge about palliative care in heart failure, high emotional impact on clinicians when undertaking ACP and lack of multidisciplinary collaboration between healthcare professionals to reach consensus on when ACP is indicated. The main facilitators were being competent to provide holistic care when using ACP in heart failure, a patient taking the initiative of having an ACP conversation, and having the resources to deliver ACP at a time and place appropriate for the patient.

Conclusions Training healthcare professionals in the delivery of ACP in heart failure might be as important as enabling patients to start an ACP conversation. This twofold approach may mitigate against the high emotional impact of ACP. Complex interventions are needed to support clinicians as well as patients to engage with ACP.

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	BMJ Supportive & Palliative Care
Publisher:	BMJ Group
ISSN:	2045-435X
Official Date:	19 August 2022
Dates:	Date Event 19 August 2022 Published 22 July 2019 Available 1 May 2019 Accepted
Volume:	12
Article Number:	e3
DOI:	10.1136/bmjspcare-2018-001747
Status:	Peer Reviewed
Publication Status:	Published
Reuse Statement (publisher, data, author rights):	“This article has been accepted for publication in BMJ Supportive & Palliative Care, 2019 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/bmjspcare-2018-001747 “Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org
Access rights to Published version:	Restricted or Subscription Access
Copyright Holders:	© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Date of first compliant deposit:	28 May 2019
Date of first compliant Open Access:	13 August 2019
Related URLs:	Publisher

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