For many families, the most difficult healthcare decisions come when loved ones can no longer speak for themselves. Many older Barbadians appear keen to spare their relatives that burden, and have expressed strong support for planning ahead so their wishes are clearly understood and respected.
That sentiment emerged from a first-of-its-kind local examination of advance directives, legal documents that allow individuals to record their preferences for future medical care before illness or incapacity leaves them unable to make decisions for themselves.
The research, Attitudes Toward Advance Directives Among Elderly Primary Care Patients Aged 65 and over in Barbados: A Qualitative Survey, was conducted by primary care physician Dr. Jenille Wharton as part of her Doctor of Medicine (DM) programme in Family Medicine at The University of the West Indies, Cave Hill Campus.
Strong endorsement
She surveyed 206 patients aged 65 and older across four polyclinics and found that three out of every four respondents had never heard of advance directives. Yet once the concept was explained, participants responded positively to the principles of planning ahead, maintaining personal autonomy and involving family members in decisions about their care.
“There was strong endorsement for persons wanting autonomy to reduce the burden on their families and to plan proactively,” she said.
Dr. Wharton noted that the emphasis participants placed on family involvement was consistent with findings elsewhere in the Caribbean.
“There were also strong scores for family involvement and that was similar to the results of studies we saw coming out of the region, coming out of Jamaica, where persons wanted their family to be part of that decision-making process. Perhaps, that might suggest we should frame advanced care planning, when we get to that point, as a family-inclusive process to increase acceptability in Barbados.”
The findings showed no significant differences in attitudes based on age, gender, education level or marital status.
No Legal Framework
The results come at a time when Barbados has no legal framework governing advance directives though facing the challenges of an ageing population. Dr Wharton said the issue is becoming increasingly important as healthcare needs shift beyond acute treatment to include long-term and palliative care.
She said the findings highlight the need to ensure patients retain a voice in their future healthcare while encouraging conversations about treatment preferences long before a medical crisis occurs.
Dr Wharton recommended greater public awareness of advance directives, further research involving both patients and healthcare providers, and expanded investigations across different populations and settings.
“Older Barbadians hold positive attitudes towards advanced directives. Despite the low awareness, the values that underpin advance directives already exist in our population, things like autonomy, choice, and planning.”
“Elderly Barbadians are ready. Are we?” she asked at the conclusion of her presentation on the findings of her research which were published at the 25th Errol Walrond Scientific Symposium in July 2026.
