ADVANCE DIRECTIVES - THE VIEWS OF HEALTH-CARE PROFESSIONALS

Objectives: This study examined the views and experiences of 20 physic ians and 20 nurses at a major Canadian teaching hospital regarding the use of advance directives in clinical care. Design: The participants were purposively drawn from four clinical specialties: family and comm unity medicine, oncology, intensive care and geriatrics. Detailed inte rviews were conducted in person. Content analysis was used to code the data, which were further analysed with both quantitative and qualitat ive techniques. Main results: Thirty-nine of the 40 participants favou red the use of advance directives in clinical care; physicians had som ewhat less positive attitudes than nurses toward such directives. Adva nce directives were thought by participants to be helpful in resolving disagreements between patients and their families about treatment opt ions; in making patients more comfortable, both physically and psychol ogically, during the process of dying; and in opening up communication and trust among patients, their families and health care professional s. Concerns about the use of advance directives focused on the lack of clarity in some patients' instructions, the absence of legal status f or directives, the possible interference with a practitioner's clinica l judgement, the adequacy and appropriateness of patients' information about their circumstances, and the type of intervention (passive or a ctive) requested by patients. Conclusions: New regulations and legisla tion are making the use of advance directives more widespread. Health care professionals should participate in the development and implement ation of these directives. Continuing professional education is essent ial in this regard.