Skip to main content
SpringerLink
Log in

The Use of Advance Directives in Specialized Care Units: A Focus Group Study With Healthcare Professionals in Madrid

  • Original Research
  • Published:
Journal of Bioethical Inquiry Aims and scope Submit manuscript

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 circumstances contribute to patients’ lack of interest in completing these documents and to physicians’ sceptical views about their usefulness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Basic Law 41/2002 of 14 November, governing the autonomy of the patient and rights and obligations with regard to clinical information and documentation

References

  • Aitken P.V. 1999. Incorporating advance care planning into family practice. American Fam Physician 59(3): 617-620.

    Google Scholar 

  • Andorno, R., D.M. Shaw, and B. Elger. 2015. Protecting prisoners’ autonomy with advance directives: ethical dilemmas and policy issues. Medicine Health Care and Philosophy 18(1): 33-39.

    Article  Google Scholar 

  • Antolín A., M. Sánchez, P. Llorens, et al. 2010. Knowledge about disease course and living wills among patients with hearth failure. Revista Española de Cardiología 63(12): 1410-1418.

    Article  Google Scholar 

  • Arauzo V., J. Trenado, G. Busqueta, and S. Quintana. 2010. Grado de conocimiento sobre la ley de voluntades anticipadas entre los familiares y los pacientes ingresados en un servicio de medicina intensiva. Medicina Clinica (Barc) 134: 448-451.

  • Braun V., and V. Clarke. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology 3(2): 77-101.

    Article  Google Scholar 

  • Carrion C., P. Gallo, and E. Sanchez. 2013. Barriers and facilitators to research translation into health care decision-making: Reviewing the evidence. Evidence Live 25-26 March. England: Oxford.

  • Champer Blasco, A., F. Cartig Monfort, and R. Marquet Palomer. 2009. Conocimientos y actitudes de los profesionales de los equipos de atención primaria sobre el documento de voluntades anticipadas. Aten Primaria 42(9): 463-469.

    Article  Google Scholar 

  • Contreras Fernández, E., F.J. Barón López, C. Méndez Martínez, J.C. Canca Sánchez, I. Cabezón Rodríguez, and F. Rivas Ruiz. 2017. Validación del cuestionario de conocimiento y actitudes de los profesionales sanitarios en el proceso de declaración de voluntades anticipadas. Aten Primaria 49(4): 233-239.

    Article  Google Scholar 

  • Contreras Fernandez, E., F. Rivas Ruiz, J. Castilla-Soto, and C. Mendez Martinez. 2015. Knowledge and attitudes of health professionals to the living will declaration process. Aten Primaria 47(8): 514-522.

    Article  Google Scholar 

  • Frith H., and K. Gleeson. 2004. Clothing embodiment: Men managing body image and appearance. Psychology of Men and Masculinity 5(1): 40

    Article  Google Scholar 

  • Glaser, B. 1965. The constant comparative method of qualitative analysis. Social Problems 12: 436-445.

    Article  Google Scholar 

  • Guyon G., L. Garbacz, A. Bauman, et al. 2014. Trusted person and living will: Information and implementation deficit. Revue de Medecine Interne 35(10): 643-648.

    Article  CAS  Google Scholar 

  • Heiman H., D.W. Bates, D. Fairchild, S. Shaykevich, and L.S. Lehman. 2004. Improving completion of advance directives in the primary care setting: a randomized controlled trial. American Journal of Medicine 117(15): 318-324.

    Article  Google Scholar 

  • Huges, R. 1998. Ethical problems in living will legislation. Journal of Religion and Aging 5(1-2): 35-50.

    Google Scholar 

  • Jox, R.J., F. Bosisio, and E. Rubli Truchard. 2018. Dementia from palliative care perspective: Why a disease-specific advance care planning is necessary. Therapeutische Umschau 75(2): 105-111.

    Article  Google Scholar 

  • Korfage, I.J., J.A. Rietjens, A. Overbeek, et al. 2015. A cluster randomized controlled trial on the effects and costs of advance care planning in elderly care: Study protocol. BMC Geriatrics 15(1): 1-6.

    Article  Google Scholar 

  • Krueger R.A., and M.A. Casey. 2014. Focus groups a practical guide for applied research. London: Sage.

    Google Scholar 

  • Llordés M.L., E. Muñoz, I. Serra Morera, and N. Giménez. 2014. Conocimientos, expectativas y preferencias respecto al documento de voluntades anticipadas entre los pacientes de atención primaria. Medicina Clínica 143(7): 309-313.

    Article  Google Scholar 

  • Mateos Rodríguez, A.A., A. Huerta Arroy, and M.A. Benito Vellisca. 2007. Instrucciones previas: Actitud de los profesionales de emergencia. Emergencias 19: 241-244.

    Google Scholar 

  • Ministry of Health, Consumption and Social Welfare. National Registry of Prior Instructions. https://www.mscbs.gob.es/ciudadanos/rnip/home.htm. Accessed May 2, 2019.

  • Molina J., M. Pérez, B. Herreros, M.D. Martin, and M. Velasco. 2011. Conocimiento y actitudes ante las instrucciones previas entre los pacientes de un hospital público de la Comunidad de Madrid. Revista Clínica Española 211(9): 450-454.

    Article  CAS  Google Scholar 

  • Monzón J.L., I. Saralegui, R. Abizanda i Camposc, et al. 2008. Recomendaciones de tratamiento al final de la vida del paciente crítico. Medicina Intensiva 32(3): 121-133.

    Article  Google Scholar 

  • Navarro Bravo, B., M. Sánchez García, F. Andrés Pretel, I. Juárez Casalengua, R. Cerda Diaz, and I. Párraga Martínez. 2011. Declaración de voluntades anticipadas: Estudio cualitativo en personas mayores y médicos de atención primaria. Aten Primaria 43: 11-7.

    Article  Google Scholar 

  • Nishie, H., S. Mizobuchi, E. Suzuki, et al. 2014. Living will interest and preferred end-of-life care and death locations among Japanese adults and over: A population-based survey. Acta med Okayama 68(6): 339-348.

    PubMed  Google Scholar 

  • Onwuegbuzie A.J., W.B. Dickinson, N. Leech, and A.G. Zoran. 2009. A qualitative framework for collecting and analysing data in focus group research. International Journal of Qualitative Methodology 8(3): 1-21.

    Article  Google Scholar 

  • Pérez, M., B. Herreros, M.D. Martin, J. Molina, C. Guijarro, and M. Velasco. 2013. Evolución del conocimiento y de la realización de instrucciones previas en los pacientes ingresados en medicina interna. Revista de Calidad Asistencial 28(5): 307-312.

    Article  Google Scholar 

  • Perez M., B. Herreros, M.D. Martin, J. Molina, and J. Kanouzi. 2016. Do Spanish hospital professionals educate their patients about advance directives? A descriptive study in a university hospital of Madrid, Spain. Journal of Bioethical Inquiry 13(2): 295-303.

    Article  Google Scholar 

  • Platts-Mills T.F., N.L. Richmond, E.M. LeFebvre, et al. 2017. Availability of advance care planning documentation for older emergency department patients: A cross-sectional study. Journal of Palliative Medicine 20(01): 74-78.

    Article  Google Scholar 

  • Santos C., M.A. Forn, R. Pérez, A. Corrales, L. Ugarriza, and C. Sales. 2007. ¿Estamos preparados los médicos de familia para ayudar a nuestros pacientes a hacer el testamento vital? Revue de Calidad Asistencial (22)5: 262-265.

  • Simon Lorda, P., M.I. Tamayo Velazquez, and I.M. Barrio Cantalejo. 2008. Advance directive in Spain. Perspectives from a medical bioethicist’s approach. Bioethics 22(6): 346-354.

    Article  Google Scholar 

  • Simón Lorda, P., M.I. Tamayo Velázquez, A. Vázquez Vicente, A. Duran Hoyo, J. Pena Gonzales, and P. Jiménez Zurita. 2008. Conocimientos y actitudes de los médicos en dos áreas sanitarias sobre las voluntades vitales anticipadas. Aten Primaria 20(02): 61-68.

    Article  Google Scholar 

  • Strauss S., D. Kuppinger, and W.H. Hartl. 2017. Quality of dying processes after commencement of the German Living will Act: Experiences of surgical intense care unit. Chirurg 88(3): 251-252.

    Article  CAS  Google Scholar 

  • Tierney, W.M., P.R. Dexter, G.P. Gramelspacher, A.J. Perkins, X.H. Zhou, and F.D. Wolinsky. 2001. The effect and discussion about advanced directives on patients satisfaction with primary care. Journal of General Internal Medicine 16(1): 32-40.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Valle Sanchez, A., S. Farrais Villalba, P.M. Gonzalez Romero, et al. 2009. Documento de voluntades anticipadas: Opinión de los profesionales sanitarios de atención primaria. Semergen 35(3): 111-114.

    Article  Google Scholar 

  • Velasco Sanz, T.R., and E. Rayon Valpuesta. 2016. Advance directives in intensive care: Health professional competences. Medicina Intensive 40(3): 152-162.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Calle Budapest 1, Alcorcón, Madrid, Spain

    Benjamín Herreros

  2. Servicio de Medicina Interna, Hospital Quirónsalud San José, Calle de Cartagena, 111, 28002, Madrid, Spain

    María José Monforte

  3. Unidad de Investigación, Hospital Universitario Fundación Alcorcón, HUFA, Unidad de Investigación, Calle Budapest 1, Alcorcón, Madrid, Spain

    Julia Molina & María Velasco

  4. Epileptology Department, University Hospital Bonn, Germany, Building 83, Venusberg-Campus 1, 53113, Bonn, Germany

    Karmele Olaciregui Dague

  5. 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

    Emanuele Valenti

Authors
  1. Benjamín Herreros
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. María José Monforte
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julia Molina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. María Velasco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karmele Olaciregui Dague
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emanuele Valenti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamín Herreros.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 58 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Herreros, B., Monforte, M.J., Molina, J. et al. The Use of Advance Directives in Specialized Care Units: A Focus Group Study With Healthcare Professionals in Madrid. Bioethical Inquiry 17, 395–405 (2020). https://doi.org/10.1007/s11673-020-09991-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11673-020-09991-w

Keywords

Search

Navigation