title: Why are advance care planning decisions not implemented? Insights from interviews with Australian general practitioners.
abstract: BACKGROUND
  Advance care planning (ACP) is thought to enhance patient autonomy and improve end-of-life care. However, there is evidence that when patients engage in ACP, the resultant plans are often not implemented. This has been attributed to either nonadherence by health professionals or inadequacies in ACP such as inaccessibility of the plans, plans providing ambiguous or conflicting instructions, and inappropriate focus on the completion of documents rather than communication. However, it is not known whether these postulated reasons are consistent with the experiences and views of health care professionals providing end-of-life care in the community.
  
  
  OBJECTIVE
  Our aim was to explore the perspectives of general practitioners (GPs) on factors influencing the implementation of ACPs.
  
  
  METHODS
  We conducted semi-structured, open-ended interviews of a purposive sample of 17 Australian GPs. Interview transcripts were analysed using constructionist grounded theory utilizing NVivo 9 software.
  
  
  RESULTS
  Factors that were considered to have an important influence on the implementation of ACPs include: ACP factors such as form, legal standing, accessibility, clarity, currency, and specificity; illness factors such as quality of life, function, diagnosis, prognosis, and prognostic certainty; family factors such as family attitudes to ACP and different conceptualizations on whether care is provided to individuals or to a family unit; and organizational and care setting factors such as health care facility's attitudes and policies in relation to end-of-life care.
  
  
  CONCLUSIONS
  Problems in implementation of ACPs are multifactorial and not necessarily due to deliberate nonadherence by health professionals. Potential solutions to improve the clinical impact of ACP are discussed.
authors: 1 Centre for Primary Health Care and Equity, University of New South Wales , Sydney, Australia .
authors: Joel J
authors: JJ
authors: Rhee
authors: Nicholas A
authors: NA
authors: Zwar
authors: Lynn A
authors: LA
authors: Kemp
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D001315:Australia; D005260:Female; D058005:General Practitioners; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012984:Software