Physicians’ Perceived Barriers and Willingness to Initiate Advance Care Planning with Young Adults Living with Cardiometabolic Diseases

Abstract

Objectives: The current global practice is to plan for the end-of-life period of persons already terminally ill with chronic diseases. However, affected persons should not have to wait till the stage of terminal illness to begin making plans for future healthcare preferences. This pilot study explored perceived barriers to and willingness of physicians to initiate discussions on advance care planning (ACP) with young adults living with cardiometabolic diseases. Materials and Methods: The study was the pilot phase of descriptive cross-sectional research conducted among primary care physicians practising in Kuwait. Pilot data was collected with an electronic version of the modified DECIDE questionnaire (adapted from the “DECIsion-making about goals of care for hospitalized ElDErly patients” study) from February to April 2023. Data were analysed with Google Sheets. Results: Nine out of 22 participants exited the study early on grounds of non-familiarity with the concept of ACP. Thirteen responses were analysed and reported herein. The mean age of the participants was 44.2 (±7.9) years; eight were male and five were female; five were Hindu, 7 Muslim, and 2 Christian. Perceived barriers to initiating ACP discussions included lack of knowledge about ACP and its relationship to ACP and goals of care discussions (8), lack of knowledge about the legal status of ACP documents in Kuwait (11), religious disapproval (12), lack of knowledge about how to elicit values, beliefs, preferences related to end-of-life care (13) and fear that these conversations will diminish hope in patients with serious illness (12), among others. Twelve participants were willing to initiate discussions and exchange information with young adult patients. Twelve participants indicated that they were confident about initiating discussions and exchanging ACP information, had all not taken any extra training or certification in ACP, but, respectively, described their current level of skill in having ACP discussions and supporting patients in the finalisation of their advance care plans as limited (2), fair (3), average (4), very good (3) and expert (1). Conclusion: Despite the low level of awareness and other factors perceived as barriers, the primary care physicians who participated in the study were confident and willing to initiate ACP discussions with young adults living with cardiometabolic diseases. With the generally reported lack of previous training in ACP, there might be a need for coordinated efforts in training or up-skilling on knowledge and practice of ACP among primary care physicians.