A study by the Catalunya Central Research Support Unit (USR) of IDIAPJGol and the ICS, led by Oriol Imbernon, a healthcare social worker from the Navarcles-Sant Fruitós Primary Care Team, and Aïna Fuster, a pharmacist from the IDIAPJGol Medicines Research Unit and Research Ethics Committee for Medicinal Products, highlights the value of healthcare social work in advance care planning in primary care.
The study, published in the scientific journal Journal of Social Work in End-of-Life & Palliative Care, involved 74 people with complex or advanced chronic diseases receiving care from primary care teams in Central Catalonia. Of these, 48 went on to formalise an advance directive with the support of healthcare social work professionals at their primary care centre.
The results show that, before receiving information, two out of three participants had little or very little knowledge of advance directives. After receiving professional support, 77% showed a high level of interest in submitting one. In addition, all those who completed the process rated the support they received positively.
Greater public awareness
An advance directive allows a person to state their preferences regarding the care and treatments they would wish to receive if, in the future, they were unable to make decisions for themselves.
During the period analysed, the number of advance directives formalised in Catalonia increased by 33%. The authors link this increase to greater public awareness and to the support model developed in primary care.
Support from social workers in primary care facilitates the process of personal reflection, helps patients make informed decisions and reinforces the value of advance directives as a tool to ensure that healthcare respects each person’s values and preferences.
Person-centred planning
This model stands out for integrating healthcare social work professionals into primary care in a structured way. This makes it possible to understand advance care planning as a process of dialogue and person-centred support, going beyond the formalisation of an administrative document.
The results reinforce the role of healthcare social work as a key component in the care of people with complex chronic conditions and provide evidence of the benefits of incorporating this support into routine clinical practice, helping to ensure that patients’ rights and preferences are respected.
How should an advance directive be formalised?
For a person’s preferences to be taken into account by healthcare professionals, they must be recorded in writing in an advance directive, also known as a living will.
The document can be formalised before three witnesses, a healthcare professional or a social worker in the healthcare field, a healthcare professional at an assisted residential care facility in the presence of a witness, or a notary.
The entry into force of Law 2/2024 in April 2024 amended Law 21/2000 on health information rights, patient autonomy and clinical documentation, introducing a significant change in the process of formalising advance directives. For the first time, the document could be formalised before a healthcare professional working in primary, hospital or social and healthcare services. Since then, the registration of advance directives in Catalonia has increased by nearly 60%.
Article reference
Imbernon Valiente, O., & Fuster-Casanovas, A. (2026). Social Work Support for People Who Wish to Draft an Advance Directive (AD) in Catalonia (Spain). Journal of Social Work in End-of-Life & Palliative Care, 1–12. https://doi.org/10.1080/15524256.2026.2706472
