title: Palliative care health professionals' experiences of caring for patients with advance care directives.
abstract: OBJECTIVE
  To explore the health professionals' (HPs) perceptions and experiences of advance care directives (ACDs) and advance care planning in Australian palliative care services.
  
  
  METHODS
  A nationwide survey of 105 palliative care services was conducted, with two HPs from each service invited to participate. A qualitative analysis of open responses about advance care planning was undertaken.
  
  
  RESULTS
  Sixty questionnaires were returned with open responses. Most responders were nurses (75%), aged ≥40 years (80%) and with a mean of 12 years palliative care experience. Data were grouped into four key themes: (1) the ACD; (2) the process of developing ACDs; (3) the process of using ACDs; and (4) the consequences of having ACDs. Participants were positive about advance care planning, commenting that ongoing communication about end-of-life care ensures mutual understanding between patients, family and HPs. Provision of care was considered easier and more efficient with an ACD in place. ACDs were perceived to reduce distrust and conflict between family, friends and HPs, and promote communication. Suboptimal documentation, clarity and explicitness limited the usefulness of ACDs when they were available.
  
  
  CONCLUSIONS
  Advance care planning benefits HPs, patients and their family. To maximise these benefits, ACDs need to be clear, comprehensive, medically relevant and transportable documents.
authors.affiliation: Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, M507, 35 Stirling Hwy, Crawley, WA 6009, Australia.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Johnson
authors.affiliation: Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, M507, 35 Stirling Hwy, Crawley, WA 6009, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Singer
authors.affiliation: Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, iC Enterprise 1, Innovation Campus, University of Wollongong, Wollongong, NSW 2522, Australia. Email.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Masso
authors.affiliation: Respecting Patient Choices Program, Austin Hospital, PO Box 5555, Heidelberg, Vic. 3084, Australia. Email:.
authors.forename: Marcus
authors.initials: M
authors.lastname: Sellars
authors.affiliation: Respecting Patient Choices Program, Austin Hospital, PO Box 5555, Heidelberg, Vic. 3084, Australia. Email:.
authors.forename: William
authors.initials: W
authors.lastname: Silvester
mesh_terms: D000328:Adult; D016223:Advance Directives; D001315:Australia; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011368:Professional-Family Relations