Nasreen Panjwani has completed her MSc in Nursing from the Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan. She is currently working as a Nurse Manager for surgical areas at the Aga Khan University Hospital, Karachi. Her past experience is of an RN in different critical care areas such as the Emergency Department and Post Anesthesia Recovery Room. She has also worked at the Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan as a Senior Instructor. She has published one article in a reputed journal.


This study explores the physicians’ and nurses’ understanding about Advance Directives (ADs) and identifies their perspectives on its importance, in the context of Pakistan. An exploratory descriptive method was adopted and a purposive sample, consisting of six physicians and seven nurses, was selected from two tertiary care hospitals in Karachi. Data was collected from participants, using a semi structured interview guide and was coded and categorized manually. Analysis of data led to four categories, such as roles of physicians and nurses in the end of life care, challenges they faced while taking end of life care decisions; their perspectives about ADs, and the scope of acceptability of ADs in Pakistan. This study revealed that patients’ families and physicians usually take decisions for patients’ end of life care. Majority of participants acknowledged the usefulness of ADs. However, they explicated some issues that may be faced in implementing ADs, particularly the issue of non-disclosure of diagnosis to the patient in the culture of Pakistan, concerns about the tedious legalization process involved, and the problem of forged documents. Participants recommended the establishment of palliative care services before the execution of ADs. This study indicated viability of ADs; however, a wider exploration would be required in terms of study population. Furthermore, reforms to support this concept would be required in systems, structure, legal policy, and training of health care professionals. Besides these transformations, promotion of public education about the advantages of ADs could enhance their acceptability among the general population.

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