title: Perspectives of Health-Care Providers Toward Advance Care Planning in Patients With Advanced Cancer and Congestive Heart Failure.
abstract: BACKGROUND
  Advance care planning (ACP) discussions afford patients and physicians a chance to better understand patients' values and wishes regarding end-of-life care; however, these conversations typically take place late in the course of a disease. The goal of this study was to clarify attitudes of oncologists, cardiologists, and primary care physicians (PCPs) toward ACP and to identify persistent barriers to timely ACP discussion following a quality improvement initiative at our health system geared at improvement in ACP implementation.
  
  
  METHODS
  A 20-question, cross-sectional online survey was created and distributed to cardiologists, oncologists, PCPs, and cardiology and oncology support staff at the NorthShore University HealthSystem (NorthShore) from February to March 2015. A total of 117 individuals (46% of distributed) completed the surveys. The results were compiled using an online survey analysis tool (SurveyMonkey, Inc., Palo Alto, California, USA).
  
  
  RESULTS
  Only 15% of cardiologists felt it was their responsibility to conduct ACP discussions with their patients having congestive heart failure (CHF). In contrast, 68% of oncologists accepted this discussion as their responsibility in patients with terminal cancer ( P < .01). These views were mirrored by PCPs, as 68% of PCPs felt personally responsible for ACP discussion with patients having CHF, while only 34% felt the same about patients with cancer. Reported documentation of these discussions in the electronic health record was inconsistent between specialties. Among all surveyed specialties, lack of time was the major barrier limiting ACP discussion. Perceived patient discomfort and discomfort of the patient's family toward these discussions were also significant reported barriers.
  
  
  CONCLUSIONS
  Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study tending to feel more personal responsibility for these discussions with patients having cancer than cardiologists with their patients having heart failure. Robust implementation of ACP across the spectrum of medical diagnoses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and the ambulatory settings.
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Chandar
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Brockstein
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Zunamon
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Irwin
authors.initials: I
authors.lastname: Silverman
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dlouhy
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ashlevitz
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Cory
authors.initials: C
authors.lastname: Tabachow
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Ewigman
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Mazzone
authors.affiliation: 1 NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Obel
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D002309:Cardiology; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D008297:Male; D008495:Medical Oncology; D009369:Neoplasms / Q000523:psychology*; D058007:Physicians, Primary Care; D013727:Terminal Care / Q000523:psychology
keywords: advance care planning; advanced cancer; congestive heart failure; end of life; physician perspectives; physician–patient discussion