Advance Care Planning in Community-Dwelling Elders

Barriers and Facilitating Factors Influencing Family Physicians

Abstract

Objective: Advance care plans (ACP) allow patients to communicate their goals for future care. This is ideally completed when the patient is still competent to make their own decisions, such as in the primary care setting. We aimed to explore common facilitating factors and barriers influencing family physicians (FPs) in initiating ACP discussions with community-dwelling elders.

Methods: Semi-structured interviews were conducted with a convenience sample of 13 FPs practicing in Vancouver, Canada. Interviews were recorded and analyzed for themes.

Results: FPs were more comfortable initiating ACP if they had a close relationship with the patient, if they were familiar with ACP terminology and if the patient or family was willing to talk about death and dying. Most physicians felt impending death facilitated discussion, while few physicians found it more difficult. FPs were often not aware of the impact of ACP on patient care, and this was highlighted by difficulties with transferring information from community to hospital. A lack of time and of a concise framework hindered ACP initiation. We noticed that numerous ACP resources existed, but may be unknown or inaccessible to physicians. There was also a lack of effective non-English ACP patient handouts.

Conclusions: The self-identified barriers and facilitating factors influencing FPs’ decision to initiate ACP were remarkably diverse and occasionally contradictory. Our research highlights a need for improved communication between healthcare providers and increased public awareness on end-of-life issues. There is also a need for increased accessibility and awareness of ACP resources, especially in non-English languages.