|Study (country)||Objectives||Design||Participants||N||Major findings|
|Yee et al., 2011  (Singapore)||To explore the knowledge, attitudes and experience of renal health-care professionals in Singapore on ACP for patients with end-stage renal failure.||A cross-sectional survey||All renal physicians, renal nurses, renal medical social workers (MSWs) and other allied health professionals working in Singapore (response rate: 90.6%)||562||
1. MSWs and physicians had higher knowledge scores than nurses and others.|
2. 82.4% of doctors and 100% of MSWs considered ACP discussions as part of their role, but only 37.1% of nurses and 38.1% of other allied health professionals thought likewise.
3. MSWs appeared to be the most confident in conducting ACP discussions. Nurses were the least confident, and most were fearful of upsetting patients and families.
4. 90% of the nurses and 71.4% of others occasionally or never discussed ACP with their patients compared to 66.6% of physicians and 53.9% of MSW. Of those who discussed ACP with their patients, 82% of the physicians and 90% of MSW initiated the discussions themselves compared to nurses (18.6%).
|Heyman, 2008  (USA)||To examine the factors associated with health care professionals’ attitudes toward the HCP, one form of an AD.||A cross-sectional survey||A random sample of nurses and social workers who were members of relevant professional associations (response rate: 34% for nurses and 46% for social workers)||213||
1. Social workers and nurses had generally positive attitudes toward the HCP, but social workers had higher attitude scores than nurses.|
2. Factors that predicted attitudes included profession and training in end-of-life care.
3. Professionals’ perception of individual/family barriers and their perception of system barriers increase, their attitude towards HCP decreases.
4. Health care professionals who had prior training in EoL planning had more positive attitudes toward the HCP than those who did not have training.
5. The top three perceived barriers against HCP were: patient discomfort in discussing the topic; patient knowledge about the HCP; and patient’s fear of death.
|Laje et al., 2007  (USA)||To assess nursing home physicians’ and social workers’ perceptions of a patient plan of care form||A cross-sectional survey||A convenient sample of physicians and social workers||37 physicians & 60 social workers||
1. 85.6% of the respondents stated that social workers are completing the form, while 49% of the physicians and 25% of the social workers said that physicians are involved in completing the form.|
2. 92.5% of the respondents stated that the patient plan of care from was completed within less than 2 weeks of admission.
|Black, 2006  (USA)||To explore differences in AD communication practices by comparing and contrasting nurses’ and social workers’ perceptions of their roles.||Qualitative interviews||A purposive sample of care professionals from a moderate-sized facility||6 nurses & 5 social workers||
1. Nurses’ communication tended to focus on pragmatic information, but social workers expressed addressing the “meaning” of the choices faced by patients.|
2. For nurses, ADs were addressed routinely with almost all of their patients through institutional admission procedures. Social workers’ AD communication practices were limited to the patients encountered through screening or referrals.
3. Social workers indicated an awareness of their roles as advocates in promoting the content of the patient’s wishes with family members as well as with other health care providers. Nurses reported advocating on the patient’s behalf with other providers.
4. When discussing the appointment of a surrogate decision maker, nurses reported urging patients to choose a family member and social workers reported encouraging patients to question the selection of a family member as a surrogate.
5. Nurses perceived particular expertise among social workers as good communicators, and social workers acknowledged nurses’ primary role with patients.
|Black, 2005b  (USA)||To examine the roles and AD communication practices of social workers as members of the interdisciplinary health care team.||A cross-sectional survey||A cluster sample of multi-disciplinary professionals employed at 6 hospitals||32 physicians, 74 nurses, 29 social workers||
1. Physicians reported the lowest frequency of initiating the AD communication while social workers reported the highest.|
2. Compared to both nurses and physicians, social workers disclosed more information about the purpose of ADs, patient rights to formulate or modify the documents, parameters about specific ADs, and the need to document patient ADs in the medical record.
3. Compared to both nurses and physicians, social workers more frequently talked with patients about potential proxy choices, assessed prospective proxy’s capacity to serve as a surrogate, and confirmed that identified proxy was willing, able, and available to serve.
4. Social workers discuss the treatment options of feeding tubes, respirators, and comfort measures more than physicians and nurses, and the option of hospice more than nurses.
5. Compared to both nurses and physicians, social workers more frequently urged patients to think about their values in living as they consider the impact of potential treatment options.
6. Social workers also differed from physicians and nurses by interacting more frequently with family and others via the request of another health care professional.
7. 52% of the social workers spent 0.5–1.0 h daily in their AD communication practices, while the physicians (90%) and nurses (86%) spent less than 0.5 h daily for AD communication.
|Werner et al., 2004  (Israel)||To examine nurses’ and social workers’ attitudes and beliefs about and involvement in LST decisions.||A cross-sectional survey||A cluster sample of nurses who were working in 3 large medical centers and a convenient sample of social workers from different health care settings.||274||
1. Whereas nurses reported being more involved in the daily care of terminally ill patients, social workers reported being more involved in discussions with patients and family members.|
2. Social workers reported consistently stronger beliefs than nurses regarding their role in the decision-making process and their role with patients and family members.
3. Nurses were more willing than social workers to use artificial feeding and less willing to use mechanical ventilation and CPR for all conditions.
|Neuman & Wade, 1999  (USA)||To explore the perceptions of health care providers as to how effective AD arrangements were in assuring compliance with the patients’ wishes, and their satisfaction levels with the process.||A cross-sectional survey||An interdisciplinary sample of health care providers practicing in a variety of settings (response rate: 33%)||116||
1. 64% of the respondents indicated that they had direct responsibility in overseeing the facility’s ADs program or in discussing ADs with patients’ families.|
2. Social workers as a group reported lower levels of satisfaction with AD laws and systems than nurses and other professionals.
3. Respondents working in hospitals were more likely to report encountering patient and family conflict regarding treatment decisions, difficulty in communicating with the patient and family and lack of adequate guidance from the medical staff.