. 2020 Jun 9:1–4. doi: 10.1159/000509103

Table 1.

Current barriers and opportunities for non-medical staff engagement in initiating end-of-life discussions

Barriers	Short-term opportunities
− A culture in healthcare that works against any change in role delineation fueled by the social expectation that doctors take the lead on prognostic disclosure and offers of treatment options − Inadequate training and skills for initiation of such complex end-of-life discussions − Feeling that their input to the conversation is vague and somewhat meaningless − Lack of support, as a profession, in having end-of-life responsibility within their scope of practice − Discomfort about implications due to the uncertainty of whether taking a leading role in end-of-life discussions could result in potential legal action by patients' families	− Accelerated refresher training on communication of bad news and ACP − Internal service policies to enable an expanded scope of practice for non-medical clinicians and work through the ability for a nurse practitioner to sign off an advanced resuscitation plan (including in end of life) − Greater protection through broader legislation, expedited law amendments to be authorized and protection to deliver these activities − Public campaign to enhance support for prognostic disclosure, open discussions on ACP by any health professional, and awareness regarding the harms of life-sustaining treatments when potentially futile

Barriers

Short-term opportunities

− A culture in healthcare that works against any change in role delineation fueled by the social expectation that doctors take the lead on prognostic disclosure and offers of treatment options
− Inadequate training and skills for initiation of such complex end-of-life discussions
− Feeling that their input to the conversation is vague and somewhat meaningless
− Lack of support, as a profession, in having end-of-life responsibility within their scope of practice
− Discomfort about implications due to the uncertainty of whether taking a leading role in end-of-life discussions could result in potential legal action by patients' families

− Accelerated refresher training on communication of bad news and ACP
− Internal service policies to enable an expanded scope of practice for non-medical clinicians and work through the ability for a nurse practitioner to sign off an advanced resuscitation plan (including in end of life)
− Greater protection through broader legislation, expedited law amendments to be authorized and protection to deliver these activities
− Public campaign to enhance support for prognostic disclosure, open discussions on ACP by any health professional, and awareness regarding the harms of life-sustaining treatments when potentially futile