Advance directives or living wills: reflections of general practitioners and frail care coordinators in a small town in KwaZulu-Natal

Abstract

Background: Living wills have long been associated with end-of-life care. This study explored the promotion of living wills by general practitioners (GPs) and frail care nursing coordinators who were directly involved in the care of the elderly in Howick, KwaZulu-Natal. The study also explored their views regarding the pro forma living will disseminated by the Living Will Society. Subjects: Seven GPs and three frail care nursing coordinators; 10 in total. Design: The design was qualitative in-depth interviews and analysis, using the Framework method. Results: Both doctors and nursing staff understood the concept of living wills and acknowledged that they were beneficial to patients, their families and staff. They were concerned about the lack of legal status of the living will. They felt that the pro forma document from the Living Will Society was simple and clear. Despite identifying the low level of living will usage among patients, doctors and nursing staff felt that third-party organisations and individuals should promote living wills to patients, rather than promoting them to patients themselves. Conclusion: GPs and frail care nurse coordinators were knowledgeable about living wills in general, and the Living Will Society pro forma document in particular. They valued the contribution that living wills make to the care of the elderly, as they benefit patients, their families, healthcare workers and the health system. They also valued the pro forma living will document from the Living Will Society for its clarity and simplicity. However, the GPs and frail care nursing coordinators viewed the living will process as patient driven. They viewed their main role to be that of custodians, and not advocates, of the living wills.