Date of Award

Spring 2022

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Leadership and Advanced Nursing Practice

Committee Chair

Dr. Bonnie Harbaugh

Committee Chair School

Leadership and Advanced Nursing Practice

Committee Member 2

Dr. Debra Copeland

Committee Member 2 School

Leadership and Advanced Nursing Practice

Committee Member 3

Dr. Kathleen Masters

Committee Member 3 School

Professional Nursing Practice

Committee Member 4

Dr. Lachel Story

Committee Member 4 School

Leadership and Advanced Nursing Practice

Committee Member 5

Dr. Elizabeth Tinnon

Committee Member 5 School

Professional Nursing Practice


Advances in healthcare technology has changed how healthcare professionals care for patients, increasing the importance of Advance Directives (ADs). ADs are legal documents describing patient end-of-life care wishes. Despite the usefulness of ADs, particularly in oncology settings, most patients do not have one.

This qualitative content analysis study examined knowledge and attitudes of ADs among oncology nurses to obtain a better understanding of ADs. Literature on ADs and nurses is dominated by quantitative research. This study addresses knowledge gaps best filled by qualitative methods.

Ten experienced oncology nurses answered eleven open-ended questions using online video conference interviews. The eleven questions corresponded to five research questions. Content analysis met rigorous standards for trustworthiness, including data saturation.

Question 1 related to nurses’ firm understanding of ADs found the category Legality and themes Written Document, Wishes for EOL Care, and Unable to Speak for Self. Question 2, related to AD barriers found the category Barriers and themes Lack of Education on AD, Convenience, and Families. Question 3, related to nurses’ views of AD found the category Usefulness, with themes Prevention of Suffering and Unintended Consequences. Question 4, related to AD benefits found the category Benefits and themes Quality of Life and Peace. Question 5, related to AD discussions found the category Quality of Interactions with themes of Timing, Compassion, and Family Inclusion.

Oncology nurse participants understood the meaning, benefits, and barriers of ADs viewed ADs as useful and held AD discussions with families and patients. Results confirmed several findings from previous studies such as barriers to AD identified by Boddy et al. (2013). Results also confirmed aspects of Ruland and Moore’s (1998) theory for a Peaceful End of Life.

Oncology nurse participants valued increased knowledge along with AD-focused discussions. Nurses estimated under 40% of their oncology patients had an AD at admission. Additionally, AD education is needed for patients, healthcare providers, and families to ease AD-related confusion, conflict, stress, and uncertainty. Further, increased AD knowledge and awareness empowers patients, families, and fellow nurses to achieve peaceful end-of-life outcomes.