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Background: Advanced care planning (ACP) is a process that supports patients to reflect on their values and preferences towards care and to share these preferences with their healthcare team. Benefits of ACP include decreasing anxiety and depression towards end-of-life for both patients and loved ones and ensuring the care patients receive aligns with their goals and preferences. Oncology nurses are well-positioned to support ACP, having both established relationships with their patients and expertise in supporting patients through health-related decision-making. However, across British Columbia’s (BC) cancer care system, opportunities for patients with cancer to engage in ACP are few and inconsistent. Therefore, the purpose of this study was to understand oncology nurses’ experiences and perspectives related to ACP conversations in BC and learn how to better support oncology nurses to engage in ACP conversations. Methods: This study was informed by an interpretive description approach to inquiry, whereby the research, from study conception to reporting of results, was firmly grounded in applied nursing practice. We conducted individual, semi-structured telephone or Zoom interviews with 19 oncology nurses across BC. Interviews were audio-recorded, transcribed, and inductively analyzed through review of each transcript. Results: Oncology nurses acknowledged the value of ACP for nursing care and patient outcomes, yet admitted they have limited engagement in ACP in their practice. Participants’ accounts suggest there is no cohesive organizational approach to ACP across nursing practice settings, nor a clear educational pathway related to ACP. Nurses described several structural barriers that limit their involvement in ACP, including a lack of time, space, and privacy to hold ACP conversations; service delivery models that inhibit nurses from establishing longitudinal relationships with patients; and team dynamics that prevent nurses from working with their multidisciplinary colleagues to support ACP conversations. Conclusion: The results highlight several structural factors that either facilitate or inhibit oncology nurses from engaging in ACP discussions with their patients and colleagues. To support oncology nurses in engaging in meaningful ACP discussions, a clear and cohesive organizational approach to ACP is needed, that includes, service delivery models that encourage ACP, organizational and leadership support, educational training, and opportunities for interdisciplinary collaboration. |
