Abstract
Few studies assessing professional opinions regarding facilitators and barriers to use of advance directives (ADs) in Korea have been reported. The aims of this study were to (1) identify facilitators and barriers to use of ADs and (2) evaluate their importance in clinical practice. To address the aims of the study, a panel of experts in end-of-life care was invited and their opinions regarding facilitators and barriers to use of ADs were solicited using a semistructured survey (round 1). The relative importance of facilitators and barriers that emerged from the survey was evaluated on a 10-point Likert scale (round 2). Forty experts participated in round 1; 38% of them completed round 2. Five facilitators were identified with regard to knowledge, legal system, patient-provider paradigm shift, public and professional education, and cultural understanding. Seven barriers emerged, including negative attitudes, lack of a legal system, Korean Confucian belief, limited support, professional incompetence, and advances in medical therapy. Knowledge and negative attitudes were the most important facilitator and barrier for successful implementation of ADs, respectively. In conclusion, public and professional education is believed to be critical to increasing knowledge and enhancing positive attitudes toward ADs and professional competence in end-of-life care. A legal model of ADs that is compatible with Korean culture is also needed.