Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews
Objective The COVID-19 pandemic has impacted the capacity for advance care planning (ACP) among patients, families and healthcare teams. We sought to identify and review the barriers to and facilitators of ACP implementation for medical staff in different settings (eg, hospitals, outpatient palliati...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/10/e075969.full |
| _version_ | 1827122374846185472 |
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| author | Yu Sun Ryota Inokuchi Masao Iwagami Nanako Tamiya Takehiro Sugiyama Kyoko Hanari Kensuke Shimada Ayaka Sakamoto Thomas Mayers |
| author_facet | Yu Sun Ryota Inokuchi Masao Iwagami Nanako Tamiya Takehiro Sugiyama Kyoko Hanari Kensuke Shimada Ayaka Sakamoto Thomas Mayers |
| author_sort | Yu Sun |
| collection | DOAJ |
| description | Objective The COVID-19 pandemic has impacted the capacity for advance care planning (ACP) among patients, families and healthcare teams. We sought to identify and review the barriers to and facilitators of ACP implementation for medical staff in different settings (eg, hospitals, outpatient palliative care, nursing and care homes) during the pandemic.Design This study employed an overview of reviews design. We searched the MEDLINE, CENTRAL, Web of Science and Embase databases for studies published between 8 December 2019 and 30 July 2023. We used AMSTAR 2 to assess the risk of bias.Results We included seven reviews. Common barriers to ACP implementation included visitation restrictions, limited resources and personnel and a lack of coordination among healthcare professionals. In care and nursing homes, barriers included a dearth of palliative care physicians and the psychological burden on facility staff. Using telemedicine for information sharing was a common facilitator across settings. In hospitals, facilitators included short-term training in palliative care and palliative care physicians joining the acute care team. In care and nursing homes, facilitators included ACP education and emotional support for staff.Conclusions Visitation restrictions and limited resources during the pandemic posed obstacles; however, the implementation of ACP was further hindered by insufficient staff education on ACP in hospitals and facilities, as well as a scarcity of information sharing at the community level. These pre-existing issues were magnified by the pandemic, drawing attention to their significance. Short-term staff training programmes and immediate information sharing could better enable ACP.PROSPERO registration number CRD42022351362. |
| first_indexed | 2024-03-11T13:42:01Z |
| format | Article |
| id | doaj.art-11f5db0cca544b3093b821477914a9ca |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2025-03-20T14:08:01Z |
| publishDate | 2023-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-11f5db0cca544b3093b821477914a9ca2024-09-11T02:05:10ZengBMJ Publishing GroupBMJ Open2044-60552023-10-01131010.1136/bmjopen-2023-075969Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviewsYu Sun0Ryota Inokuchi1Masao Iwagami2Nanako Tamiya3Takehiro Sugiyama4Kyoko Hanari5Kensuke Shimada6Ayaka Sakamoto7Thomas Mayers8Institute for Global Health and Development, Peking University, Beijing, ChinaDepartment of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan4 Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, JapanDepartment of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan3 Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Shinjuku-ku, JapanDepartment of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JapanDepartment of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, JapanDepartment of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, JapanMedical English Communications Center, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, JapanObjective The COVID-19 pandemic has impacted the capacity for advance care planning (ACP) among patients, families and healthcare teams. We sought to identify and review the barriers to and facilitators of ACP implementation for medical staff in different settings (eg, hospitals, outpatient palliative care, nursing and care homes) during the pandemic.Design This study employed an overview of reviews design. We searched the MEDLINE, CENTRAL, Web of Science and Embase databases for studies published between 8 December 2019 and 30 July 2023. We used AMSTAR 2 to assess the risk of bias.Results We included seven reviews. Common barriers to ACP implementation included visitation restrictions, limited resources and personnel and a lack of coordination among healthcare professionals. In care and nursing homes, barriers included a dearth of palliative care physicians and the psychological burden on facility staff. Using telemedicine for information sharing was a common facilitator across settings. In hospitals, facilitators included short-term training in palliative care and palliative care physicians joining the acute care team. In care and nursing homes, facilitators included ACP education and emotional support for staff.Conclusions Visitation restrictions and limited resources during the pandemic posed obstacles; however, the implementation of ACP was further hindered by insufficient staff education on ACP in hospitals and facilities, as well as a scarcity of information sharing at the community level. These pre-existing issues were magnified by the pandemic, drawing attention to their significance. Short-term staff training programmes and immediate information sharing could better enable ACP.PROSPERO registration number CRD42022351362.https://bmjopen.bmj.com/content/13/10/e075969.full |
| spellingShingle | Yu Sun Ryota Inokuchi Masao Iwagami Nanako Tamiya Takehiro Sugiyama Kyoko Hanari Kensuke Shimada Ayaka Sakamoto Thomas Mayers Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews BMJ Open |
| title | Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews |
| title_full | Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews |
| title_fullStr | Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews |
| title_full_unstemmed | Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews |
| title_short | Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews |
| title_sort | barriers to and facilitators of advance care planning implementation for medical staff after the covid 19 pandemic an overview of reviews |
| url | https://bmjopen.bmj.com/content/13/10/e075969.full |
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