Role self-ascription of professionals conducting advance care planning conversations: A thematic analysis

Abstract

Background: During advance care planning, individuals can benefit from the support of a healthcare professional to navigate the intricacies of decision-making. There are specific roles to be played at each level of the process. Evidence is lacking about how professionals understand their role when conducting advance care planning conversations.

Aim: To explore how professionals perceive, define and describe their role when conducting advance care planning conversations.

Design: We conducted this exploratory cross-sectional study in Switzerland from November 2019 to June 2020 by using semi-structured interviews, which were transcribed and thematically analysed with an inductive approach.

Participants: Fourteen professionals having received a training on advance care planning in Switzerland.

Results: We identified three themes: (1) role typology; (2) individual-centred and (3) professional-centred aspects related to role ascription. Roles that professionals undertake were aggregated in two overarching categories, 'facilitators' and 'counsellors', according to whether they prioritise individual's capacity to decide for themselves or their need to receive guidance towards a particular decision. In practice, roles fluctuate between these categories, according to the individuals (to what extent they are informed and eager to engage in autonomous decisions, their communication capacity and desires) or the professional (main profession and involvement in the person's care plan).

Conclusions: Advance care planning requires professionals to be very adaptable and flexible in order to identify the role that they can play in each situation. Training needs to take into consideration this complexity and address it explicitly.

Keywords: Advance care planning; communication; palliative care; role.