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Promoting advance care planning (ACP) in community health clinics in Israel: Perceptions of older adults with pro-ACP attitudes and their family physicians

Published online by Cambridge University Press:  03 February 2022

Adi Finkelstein Open the ORCID record for Adi Finkelstein [Opens in a new window] ,
Shirli Resnizky ,
Yafit Cohen ,
Randi Garber ,
Ruth Kannai ,
Yisrael Katz  and
Ohad Avni
Adi Finkelstein*
Affiliation:
Department of Nursing, Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel
Shirli Resnizky
Affiliation:
The Myers-JDC-Brookdale Institute, Jerusalem, Israel
Yafit Cohen
Affiliation:
The Myers-JDC-Brookdale Institute, Jerusalem, Israel
Randi Garber
Affiliation:
JDC-Israel-Eshel, Jerusalem, Israel
Ruth Kannai
Affiliation:
Department of Family Medicine Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Yisrael Katz
Affiliation:
Department of Family Medicine, Clalit Health Services, Jerusalem, Israel
Ohad Avni
Affiliation:
Department of Family Medicine, The Hebrew University of Jerusalem, Israel
*
Author for correspondence: Adi Finkelstein, Department of Nursing, Jerusalem, Israel. E-mail: adilan@netvision.net.il
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Abstract

Objective

We examined barriers and facilitators to patient-family physician discussions in Israel about advance care planning, including preparation of an advance directive by adults over age 65, as part of a program in two community health clinics which afforded family physicians the opportunity to dedicate time to such discussions with patients. To the best of our knowledge, the program is the first of its kind in Israel.

Method

We used thematic analyses of qualitative data collected through 22 interviews with patients with pro-advanced care planning attitudes and three focus groups with eleven family physicians.

Results

Overall, three themes in the interviews with patients and two themes in the focus groups with physicians emerged. The program gave people with pro-advanced care planning attitudes the opportunity to follow through with their ideas. We found that patients viewed their family physicians as facilitators and that the use of an information leaflet was an effective way to promote advance directives. Family physicians expressed positive attitudes toward assisting patients in the preparation of advance directives and welcomed an allotment of time for this endeavor as part of their schedule but expressed hesitation about assisting patients concerning legal and moral issues.

Significance of results

A pro-advanced care planning attitude is not enough for patients to complete the process of creating an advance directive; patients need active encouragement and intervention in order to turn their ideas into action. More patient and physician education are necessary to enable patients to protect their right to self-determination in end-of-life medical decision-making and to support physicians as facilitators of the process.

Keywords

Advance care planningAdvance directivesFamily physiciansIsraelOlder adults
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 1 , February 2023 , pp. 83 - 92
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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