Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care.
Heather Nelson-Brantley, Carol Buller, Christie Befort and 3 others
PMID 31545557WHAT IT FOUND
Most research on advance care planning focuses on starting the conversation, leaving gaps in how to identify patients, document wishes, or follow up.
Nurses and providers struggle with role ambiguity and time, not just lack of knowledge.
Key findings
01The literature heavily favors the 'conversation' step of advance care planning, with almost no research on the 'follow-up' step.
02Providers cite role identity conflicts, such as the duty to cure versus planning for death, and lack of time as major barriers, rather than just insufficient training.
03Rural primary care settings are understudied, with few articles specifying rurality or comparing determinants by rural versus urban status.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The review focused only on primary care, excluding hospitals and nursing homes, so findings may not apply to those settings. Only English-language studies were included, potentially missing important work from rural areas in Asia and South America. The review did not include studies on palliative care broadly, only those specifically addressing ACP. Most included studies were qualitative, which identifies potential barriers but does not rank their importance or prove which interventions work. Rural-specific data was very limited, so implications for rural practice are hypothesis-generating rather than evidence-based.
Declared interests
The authors did not report any conflicts of interest or funding sources in the provided text.
The easy way to misread this
Do not assume this review proves that any specific intervention improves advance care planning outcomes. It is a scoping review that maps barriers and gaps in the literature. It does not test treatments or measure patient outcomes, so it cannot tell you which strategy will work in your clinic.