Date of Conferral

10-2-2026

Date of Award

October 2026

Degree

Ph.D.

School

Social Work

Advisor

Julia Burns

Abstract

Advance care planning and advance directives are essential to patient-centered healthcare; however, limited research has examined how social workers facilitate advance directive documentation in healthcare environments. The purpose of this generic qualitative study was to explore how social workers describe and navigate the facilitation of advance directive documentation, including medical power of attorney, living wills, and out-of-hospital do-not-resuscitate orders, within healthcare settings. Guided by ecological systems theory, this study examined how procedural, relational, and contextual factors across interacting systems influence social workers’ facilitation practices. Data were collected through semi structured one-on-one interviews with eight licensed social workers with direct experience facilitating advance directives inpatient care and outpatient healthcare settings. Data were analyzed using inductive thematic analysis, resulting in five overarching themes: (a) patient readiness and timing, (b) family dynamics, (c) education and misconceptions, (d) interdisciplinary and organizational influences, and (e) cultural and systemic factors. The findings indicate that advance directive facilitation is a complex, multilevel process shaped by individual, interpersonal, organizational, and societal influences. Social workers play a critical role in navigating these factors by adapting communication strategies, addressing knowledge gaps, and advocating for patient-centered decision making. These findings may inform positive social change in social work practice, education, and healthcare systems by highlighting opportunities to improve training, interdisciplinary collaboration, and access to advance care planning resources, ultimately supporting more equitable and effective patient care.

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