Physicians' and nurses' perspectives on the importance of advance directives in tertiary care hospitals of Karachi

Date of Award


Document Type


Degree Name

Master of Science in Nursing (MScN)


School of Nursing and Midwifery, Pakistan


The aim of this study was to explore the physicians' and nurses' understanding about Advance Directives and to identify their perspectives on its importance, in the context of Pakistan. Methodology: An exploratory descriptive method was adopted for the study. A purposive sample, consisting of six physicians and seven nurses, was selected from two different tertiary care hospitals in Karachi, Pakistan, for participation in this study. Data was collected from the participants from February to June, 2014, using a semi structured interview guide. These interviews were audio recorded and transcribed verbatim. The data was coded and categorized manually. Results: Analysis of the data led to four categories and further sub categories. The main categories included: roles of physicians and nurses in the end of life care, the challenges they faced while taking end of life care decisions; their perspectives about ADs, and the scope of acceptability of ADs in Pakistan. This study revealed that patients' families and physicians usually take the decisions for the patients' end of life care. The findings indicated that a majority of the participants acknowledged the usefulness of ADs. However, they also explicated some of the issues that may be faced in implementing ADs, particularly the issue of non-disclosure of diagnosis to the patient in the culture of Pakistan, the concerns about the tedious legalization process involved, and the problem of forged documents. The findings also revealed that the participants recommended the establishment of palliative care services before the execution of ADs.Conclusion: The study indicated the viability of ADs; however, a wider exploration would be required in terms of the study population. Furthermore, reforms to support this concept would be required in terms of systems, structure, a stringent legal policy, and training of health care professionals. Besides these transformations, promotion of public education about the advantages of ADs could enhance their acceptability among the general population. vii

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