Research Proposal Literature Review, Rough Draft Essay

Research Proposal Literature Review, Rough Draft Essay

Advance care planning is an essential aspect of healthcare, especially in end-of-life care. Advance care planning is considered in old and younger ages since an illness crisis may leave individuals unable to make healthcare decisions and directives themselves. At this point, the family and close relatives decide for them, but if they had planned their directives before the crisis, the directive and decisions they had made would have been used. This section reviews the available literature regarding advance care planning. The review will focus on the literature on engaging more patients to complete health directives, the effect of advance care planning on end-of-life-care experience, barriers in advance care planning, and the relationship between advance care planning and a patient’s length of hospital stay.

According to Gallagher, Bolt & Tamiya (2020), less than 30% of all US residents have completed an advance directive to guide care when seriously ill, meaning that only 1 in 3 adults have planned care. Although the number is low, there has been care provider-focused efforts to bring more people to have this uncomfortable conversation and get more people to complete advance directives. Some of the strategies that have been used to facilitate the increase in the number of people completing advance directives include Medicare payment for advance care planning and the use of self-service platforms to indicate preferences for future care. The methods have been effective, even though the number is still low.

Communication and extensive patient education can help increase the number of people using advance care planning and completing advance directives. According to Wasserman et al. (2019), communication between the care providers and the patient is essential in advance care planning and completing advance directives. The care providers are responsible for providing information on advance care planning to patients, especially terminally ill and geriatric patients. Information on the available options in end-of-life care, and their consequences, would increase the number of people completing advance directives, given that inadequate information, awareness, and knowledge on the same is a major barrier to advance care planning (Wasserman et al., 2020).

Additionally, health promotion through patient education is another strategy for getting people to engage in the conversation about advance directives and care planning. According to McMahan, Tellez & Sudore (2021), advance care planning is a requirement for both ill and healthy people, old and young, since any medical crisis may occur, leaving an individual incapacitated and unable to make care decisions or select a directive. Therefore, health promotion initiatives focusing on advance care planning in the community and patient education to patients and their families can be used to get more people to engage in advance care planning.

Advance care planning has been found to contribute positively to patient satisfaction in end-of-life care, decreased healthcare cost utilization, decreased chances of demise in hospitals, and increased use of life-sustaining treatment (Xu et al., 2021). Being aware that if anything happens and leaves a person in a situation, they cannot speak for themselves. Yet, knowing that their preferences and wishes will be considered raises a patient’s confidence and enhances satisfaction. It also gives the patient and the family members peace of mind, thus improving the end-of-life care experience. According to Gallagher et al. (2020), patients who have engaged in advance care planning and have advance directives have a shorter hospital stay than patients without advance directives since most prefer not to get life-sustaining care.

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There are various barriers to advance care planning. Research shows that some potential barriers to the completion of advance directives include inadequate awareness of advance care planning, lack of knowledge about advance care planning in many patients, and lack of time dedicated by physicians to deliver patient education and counseling on advance care planning (Xu et al., 2021). Despite advance care planning being supported by state laws across the nation, the movement of awareness creation and education on advance care planning and advance directives is low. Time allocated for counseling and patient education on advance care planning is also considerably low, thus a major barrier to the completion of advance directives (Xu et al., 2021).

The other barriers to completing advance directives include confusion, denial, and cultural differences (, n.d.). Many people would prefer quality end-of-life care. However, there is confusion and worry between personal wishes and potential conflicts regarding the best action to take to extend a patient’s life and, at the same time, ensure quality in end-of-life care. A study by Sean Morrison (2020) found that most people worry that making decisions on end-of-life care may interfere with doing what is required to extend their lives, thus better not complete advance directives. The confusion can be addressed by engaging patients in a conversation on preparing end-of-life care and helping them understand the different directives and their influence on their care and end-of-life.

Denial of death and dying and being in a circumstance whereby a person is incapacitated and unable to speak for oneself is another barrier to completing an advance directive. Due to denial, people do not embrace the fact that life closures are as important as life. Provision of information and preparation of the process, especially for chronically ill patients, would help deal with the denial and bring more people to embrace advance care planning and to complete advance directives.

In a review, Orlovic, Smith & Mossialos note a positive relationship between racial and ethnic differences in end-of-life care and advance care planning. Most Medicare beneficiaries (who have completed advance directives) from all ethnic and racial groups prefer to die at home with no life-sustaining treatment. For instance, compared to whites, blacks are more likely to use intensive care and life-sustaining treatment, while whites prefer directives such as do not resuscitate for reasons such as avoiding high end-of-life costs. Cultural differences are, therefore, a barrier to advance care planning and directives.

Based on the literature reviewed above, advance care planning is essential for both ill and healthy individuals. Despite the low number of people completing advance directives, there have been efforts to get more people complete advance directives. However, researchers agree that the existing barriers to advance care planning significantly contribute to the low number of people completing advance directives (Sean Morrison, 2020; Xu et al.,2021). Furthermore, advance care planning enhances patient satisfaction in end-of-life care, reduces the length of hospital stay, and prevents unnecessary costs in life-sustaining care (Xu et al., 2021). Therefore, it is essential to use the available strategies to bring more people to complete advance directives.

In conclusion, the literature review has depicted the importance of advance care planning in end-of-life care, especially for terminally ill patients. However, there is a gap in the available information on research focused on nursing homes. Most of the deaths approximately 25% of older adults die in nursing homes, and the number is projected to increase with the aging population. Therefore, extensive research must identify how advance care planning can be enhanced in nursing homes and other long-term care facilities.



Centers for Disease Control and Prevention. (n.d.). Advance Care Planning: Ensuring your Wishes Are Known and Honored When You are Unable to Speak for Yourself. Retrieved from

Gallagher, J., Bolt, T., & Tamiya, N. (2020). Advance care planning in the community: Factors of influence. BMJ supportive & palliative care, bmjspcare-2020-002221. Advance online publication.

McMahan, R. D., Tellez, I., & Sudore, R. L. (2021). Deconstructing the complexities of advance care planning outcomes: what do we know and where do we go? A scoping review. Journal of the American Geriatrics Society69(1), 234-244.

Orlovic, M., Smith, K., & Mossialos, E. (2019). Racial and ethnic differences in end-of-life care in the United States: Evidence from the Health and Retirement Study (HRS). SSM-Population Health7, 100331.

Sean Morrison, R. (2020). Advance directives/care planning: clear, simple, and wrong. Journal of Palliative Medicine23(7), 878-879.

Wasserman, J., Palmer, R. C., Gomez, M. M., Berzon, R., Ibrahim, S. A., & Ayanian, J. Z. (2019). Advancing Health Services Research to Eliminate Health Care Disparities. American Journal of Public Health109(S1), S64–S69.

Xu, C., Yan, S., Chee, J. Lee, E. P., Lim, H. W., Lim, S. W. & Low, L. L. (2021). Increasing the completion rate of the advance directives in primary care setting – a randomized controlled trial. BMC Fam Pract 22, 115.

The literature review is one of the most important components, and often the most time consuming part, of a good research proposal. Without the solid foundation of a good literature review, it is difficult to make a strong research proposal.

This week, you will work to develop a rough draft of your literature review. You will continue to develop the literature review next week based on feedback provided by your instructor. Then in week 7, you will submit a well-polished literature review as part of your final research proposal.

The following requirements should be met in your literature review:

  • Include a minimum of six scholarly sources
  • Organize in logical sections
  • Include an overview of the literature
  • Be unbiased in your presentation of information
  • Include sources and content relevant to your research questions and hypothesis; state the relevance in your literature review
  • Include a critical assessment of the sources. Do not simply include a summary of what you have read
  • A strong introduction and conclusion, including further questions for research
  • Proper APA formatting, citations, and references

Keep in mind that this is a rough draft, so the literature review does not need to be perfect. However, you should still submit a literature review with proper APA formatting, correct spelling, punctuation, and grammar that meets all of the specifications of the assignment listed above. You will then receive feedback from your instructor and continue to do more research, and modify and improve your current literature review.

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