Knowledge and attitudes towards living wills among healthcare professionals, residents and relatives in nursing homes: A qualitative study

Living wills are a tool to support the principle of autonomy in end-of-life situations, when the person does not have the capacity to make decisions. The aim was to explore the knowledge and attitudes of residents, relatives and healthcare professionals in nursing homes in Cantabria regarding living wills. A qualitative phenomenological design was conducted. Two focus groups were held with seven participants in each group. A sample of 14 people participated in this study: four residents, five relatives and five professionals. This study was approved by the Clinical Research Ethics Committee of Cantabria. Two main categories were found, with six subcategories each: death, with six subcategories-as a social taboo, as a natural process, facing death, accompanying uncertainties, unnecessary lengthening of life and guilt-and living wills, with six subcategories-knowledge, unknowingness or misconceptions, usefulness, strategies to promote dissemination, intention of granting a living will and the professional's role in restricting or promoting autonomy. Unknowingness or misconceptions and uncertainties in relation to death were the most represented subcategories of each category. Although the attitudes among the study participants were mostly positive, there is a lack of knowledge concerning living wills, which is enhanced by the social taboo related to death.