The process of completing and executing advance directives (ADs) is not without problems and issues that need to be studied. Nurses, by the nature of their practice, are in a unique position to help patients complete ADs. The findings reported in this article focus on an open-ended question that was part of a larger quantitative survey. The open-ended question, 'What do oncology nurses need to increase their ability to assist patients with ADs?' was asked of a random sample of Oncology Nursing Society members. The Knowledge, Attitudinal, Experiential Survey on Advance Directives instrument was used to survey a random sample of oncology nurses in four states: California, Illinois, New York, and Texas. Of the 900 nurses who responded to the survey, 677 (75%) wrote responses to the open-ended question. Grounded theory was used to analyze data to establish and saturate categories. The four topics discussed most often by the nurses were time, education, support, and the nurse's role. Nurses also wrote about philosophical issues related to dying, end-of-life issues, and ADs, as well as institutional issues that have an impact on the assistance they can give patients completing ADs. In addition, the category 'communicating' was frequently discussed by nurses. The importance of communication was a thread woven throughout their responses.
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