title: Uptake and implementation of Advance Care Planning in Australia: findings of key informant interviews.
abstract: OBJECTIVE
  Advance Care Planning (ACP) has an important role in enhancing patient autonomy and guiding end-of-life care. However, there is low uptake of ACP and evidence that advance care plans are often not implemented. We explored these issues in interviews with expert clinicians and representatives of key stakeholder organisations with interest in end-of-life care.
  
  
  METHODS
  Qualitative descriptive study of semi-structured telephone interviews with 23 participants.
  
  
  RESULTS
  Participants thought that the low uptake of ACP in Australia is a result of inadequate awareness, societal reluctance to discuss end-of-life issues, and lack of health professionals' involvement in ACP. Problems in implementation of advance care plans were thought to be a result of problems in accessing ACP documents; interpreting written documents; making binding decisions for future unpredictable situations; and paternalistic attitudes of health professionals and families. Participants had different perspectives on how advance care plans should be implemented, with some believing in strict implementation, whereas others believed in a more flexible approach.
  
  
  CONCLUSIONS
  Low uptake and poor implementation of advance care plans may be addressed by (1) increasing community awareness; (2) encouraging health professional involvement; and (3) system-wide implementation of multi-faceted interventions. A patient-centred approach to ACP is required to resolve the differences in views on how advance care plans should be implemented.
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia. j.rhee@unsw.edu.au
authors.forename: Joel J
authors.initials: JJ
authors.lastname: Rhee
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Zwar
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Kemp
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D001315:Australia; D004059:Diffusion of Innovation; D006801:Humans; D007407:Interviews as Topic; D013727:Terminal Care / Q000458:organization & administration