Newspaper coverage of advance care planning during the COVID-19 pandemic: Content analysis

Figures & data

Figure 1. Flowchart of the inclusion of newspaper articles.

Table 1. Characteristics of the newspaper articles that referred to advance care planning and COVID-19 (n = 131).

Characteristics	n (%)
Country
United Kingdom	59 (45)
Canada	32 (24)
United States	15 (11)
Australia	14 (11)
Ireland	6 (5)
Other: Uganda (1), India (1), New Zealand (1), Israel (1) and France (1)	5 (4)
Article type
News report	102 (78)
Citing professionals (e.g., healthcare professionals, government spokesperson, researcher)	65 (50)
Citing patient/family/public	6 (5)
Citing both professionals and patients, family, or the general public	17 (13)
Opinion articles	22 (17)
Letters to the editor	6 (5)
Interview	1 (1)
Author
Journalist	89 (68)
Healthcare professional	20 (15)
Healthcare / ACP organization	10 (8)
Researcher	6 (5)
Governmental organization	3 (2)
Other	3 (2)
Setting described in the article
Healthcare setting
Nursing home	47 (36)
Hospital	29 (22)
Legal	25 (19)
General practice	20 (15)
Intensive care unit	14 (11)
Palliative care	15 (11)
Hospice	9 (7)
Other setting
Government	49 (37)
Financial	9 (7)
Other	3 (2)

Table 2. Elements of advance care planning (ACP) which were discussed in the newspaper articles (n = 131).

ACP^a elements	n (%)
Information about ACP	82 (63)
Readiness/timing for ACP	57 (44)
Exploration of treatment and care preferences	122 (93)
Exploration of values/goals	37 (28)
Treatment and care options	105 (80)
Do-not-resuscitate orders (DNR)/Cardiopulmonary resuscitation (CPR)	49 (37)
Admission to hospital/hospital treatment	45 (34)
Artificial ventilation	40 (31)
Admission to the intensive care unit	18 (14)
Treatment and care preferences	95 (73)
Discussion of treatment and care preferences	93 (71)
Discussion with relatives	73 (56)
Discussion with healthcare professionals	67 (51)
Recording of treatment and care preferences	94 (72)
Appointment of a personal representative	35 (27)
Recording of ACP preferences	90 (69)
Sharing the document	33 (25)

^aAdvance care planning.

Table 3: Reasons to consider engaging in advance care planning as described in the newspaper articles (n = 87).

Reason	n (%)	Illustrative example
To avoid a situation where an individual cannot communicate and their preferences are unknown.	31 (36)	“Having a health directive is a gift that we can give our loved ones, so they don’t have to guess, and we still participate in our healthcare even when we lose the ability to communicate or if we lose capacity to do those things” (article 124, Canada) (McCall, 2020)
To avoid unwanted medical treatment.	24 (28)	“If you become seriously unwell with COVID-19 and are likely to benefit from active treatment and need a ventilator or are dying, do those closest to you know what type of care you would want?” (article 55, Australia) (Hickman, 2020)
To avoid family and friends being put in a difficult position if they are required to make decisions in the absence of knowing their dependent’s/relative’s preferences.	22 (25)	“With an advance care plan in place, relatives and clinicians have a much clearer idea what the patient would want medically, even if they are too unwell to express it. This translates into a better bereavement process for relatives, should the patient die.” (article 46, UK) (Selman, 2020b)
The shortage of resources due to COVID-19 (i.e., shortage of healthcare professionals to discuss preferences, shortage of IC beds).	22 (25)	“Do I use the last ventilator for the frail 80-year-old grandmother who has a small chance of surviving the coronavirus or the 35-year-old mother who has a much higher chance? These will be devastating decisions for all involved, including my colleagues. Now, imagine that last ventilator is used on a patient who did not really want it or did not want it for long. If her loved ones had taken the time to ask, I would have the information I need to make the best decisions when it matters most.” (article 128, Canada) (Ruenfeld, 2020)
The increased risk of severe illness or risk of dying due to COVID-19.	11 (13)	“With more than 170,000 coronavirus deaths worldwide so far, including 71 in Australia, the COVID-19 pandemic has highlighted the importance of talking to your loved ones about dying and your wishes at the end of your life.” (article 55, Australia) (Hickman, 2020)
To reduce pressure/stress among healthcare professionals.	9 (10)	“There have been an increasing number of stories in the media about the extreme stress the COVID-19 pandemic is placing on front-line workers including physicians, being put in the untenable position of having to make end-of-life decisions for patients – without clear direction from them – only increases the stress.” (article 8, USA) (Compassion & Choices, 2020)

McCall, D. M. (2020). Three things you should do while self-isolating at home. Red Deer Advocate, April 8.

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Hickman, L. D. (2020). Does anyone know what your wishes are if you’re sick and dying from coronavirus? The Conversation, April 21.

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Selman, L. (2020b). How coronavirus has transformed the grieving process. The Conversation, April 17.

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Ruenfeld, G. (2020). The coronavirus is a chance to have the end-of-life conversation we need. The Globe and Mail, March 17.

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Compassion & Choices. (2020). Compassion & choices: federal gov’t urged to reverse new waiver that could result in increased rationing of care. Contify Life Science News, 30 April.

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Data availability statement

Raw data were generated at the Erasmus MC, University Medical Center Rotterdam. Derived data supporting the findings of this study are available from the corresponding author [DvdS] on reasonable request.