Barriers and Solutions to Advance Directive Creation for Adult Oncology Patients: A Literature Review

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This paper is a literature review of 20 articles to determine barriers to advance directive creation and potential solutions to these barriers for adult oncology patients. Common themes from the literature review are patient-specific barriers, provider-specific barriers, and general communication barriers between patients and providers. Minorities and those with low socioeconomic status are less likely to have completed advance directives. Many patients do not have good understanding of advance directives; the end of life is a taboo topic, resulting in low rates of advance directive completion despite the known benefits of advance care planning. Provider-specific barriers include discomfort about bringing up a sensitive topic or feeling like there is not enough time for end-of-life discussions. Communication barriers occur when providers wait until a late-stage of the disease to initiate a conversation or when they want to stay positive for their patients. Advance care planning should be a routine part of care for oncology patients, and conversations should be initiated early on in the treatment process. Additionally, those at risk for not having an advance directive should be specifically targeted for advance care planning.

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