Physicians’ and Nurses’ perspectives on the importance of advance directives in tertiary care hospitals

Objective: This study aimed to explore and identify the nurses’ and physicians’ views about Advance Directives and identified their perspectives on its importance, in the context of Pakistan. Methodology: Using a purposive sample, six physicians and seven nurses from two tertiary care hospitals in Karachi participated in the study. Data was collected using semi structured interviews that were transcribed verbatim. The interviews were coded and categorized manually. Analysis of the data drew four categories: roles of physicians and nurses in the End of life care, challenges they faced while taking end of life care decisions; their perspectives about Advance Directives, and the scope of acceptability of Advance Directives in the context of a Pakistani society. Results: This study revealed that patients’ families and physicians usually take decisions for patients’ End of Life care. Although majority of participants acknowledged the usefulness of Advance Directives, they explicated several issues that may be encountered in implementing it. The issues included non-disclosure of diagnosis to the patient in Pakistani culture, the tedious legalization process involved, and the potential problem of forged documents. Conclusion: Participants recommended establishment of Palliative Care services before execution of Advance Directives. This study indicated viability of Advance Directives; however, a wider exploration would be required in terms of study population. Reforms to support this concept would be required in systems, structure, legal policy, and training of Health care professionals. Besides these transformations, promotion of public education about the advantages of Advance Directives could enhance their acceptability among the general population.