Purpose: The study aimed to elaborate nurses’ experiences and identify their barriers in ACP for patients with CKD.
Methods: A purposive sampling was used to recruit nurses who had worked at least one year in nephrology department from one medical center and four regional hospitals. A qualitative content analysis was applied to examine the interview data from six focus groups with a total of 33 participants.
Results: Seven major themes were revealed as follows:
Theme 1: ACP is often considered to be related to death, which is a taboo issue in Taiwanese society; Theme 2: It is difficult to find a good timing to discuss ACP with patients; Theme 3: A lack of knowledge of ACP and communication skills; Theme 4: Patients or their family members refuse discussing ACP due to certain misunderstanding; Theme 5: Nurses consider themselves lacking the characteristics to discuss ACP with patients; Theme 6: Conflicts regarding ACP belief occurred between doctors and nurses; Theme 7: Initiating ACP is not only nurses’ responsibility.
Conclusion: The findings will help HPs better understand the nurses’ barriers in discussing ACP with CKD patients. Its implications are as follows. First, HPs should enhance their knowledge and skills of ACP in order to facilitate the shared decision-making process. Second, HPs should encourage patients and their family to participate in decision making to avoid medical futility. Third, health providers are recommended to initiate ACP and further discuss in detail to improve end-of-life care. If HPs can be aware of these barriers and work together with one another, ACP as the norm for everyone can become possible in the near future.