Paper
Wednesday, July 11, 2007
This presentation is part of : End-of-Life Strategies
An Evaluation of Nurse Practitioner Participation in End-of-Life Treatment Decisions
Randy M. Caine, EdD, RN, School of Nursing, California State University Los Angeles, Los Angeles, CA, USA
Learning Objective #1: describe the extent to which nurse practitioners discuss end-of-life treatment decisions with patients and/or their representatives.
Learning Objective #2: summarize under what circumstances nurse practitioners discuss end-of-life treatment decisions with patients and/or their representatives.

Assisting patients to participate in future health care decisions by utilizing advance directives is an important advocacy role for nurse practitioners (NPs).  There has been limited research examining the role of the NP with respect to end-of-life and advance directive planning.  This study was undertaken to determine to what extent and under what circumstances NPs discuss these issues with patients. 

This descriptive survey examined NP practices with respect to end-of-life and advance directive discussions.  Tools were developed to determine if NPs provided information that could be used in planning and, if so, under what circumstances. 

A systematic random sample of 600 nurse practitioners in California, USA were surveyed.  Responses from 297 NPs representing a wide variety of practice areas were grouped according to demographic information.  Data indicated that nearly two-thirds of the NPs (64%) discussed end-of-life and advance directives; however, of those, only 4% discussed them routinely.  Respondents discussed these issues with healthy patients less than 10% of the time and with patients older than 65 only 11% of the time. There were significant differences in discussions based on NP specialty (p = .0006) and practice setting (p =.00002).

Nurse practitioners function in many settings, providing health promotion and disease prevention.  Results of this study support the value of early end-of-life and advance directive planning between patients and NPs and contribute to the advocacy role. There is a need for increased education regarding attitudes toward the subject as well as barriers to these discussions by NPs.  Further study is warranted.