title: 'Not yet' and 'Just ask': barriers and facilitators to advance care planning--a qualitative descriptive study of the perspectives of seriously ill, older patients and their families.
abstract: OBJECTIVE
  To explore seriously ill, older hospitalised patients' and their family members' perspectives on the barriers and facilitators of advance care planning (ACP).
  
  
  METHODS
  We used qualitative descriptive study methodology to analyse data from an interviewer administered, questionnaire-based, Canadian multicentre, prospective study of this population.
  
  
  RESULTS
  Three main categories described these barriers and facilitators: (1) person (beliefs, attitudes, experiences, health status), (2) access (to doctors and healthcare providers, information, tools and infrastructure to communicate ACP preferences) and (3) the interaction with the doctor (who and how initiated, location, timing, quality of communication, relationship with doctor).
  
  
  CONCLUSIONS
  Based on the findings, we suggest strategies for both healthcare systems and individual healthcare providers to improve the quality and quantity of ACP with this population. These include assessing readiness for participation in ACP and personalising relevance of ACP to each individual, routinely offering scheduled family meetings for exploring a person's own goals and sharing information, ensuring systems and policies are in place to access previous ACP documentation and ensuring doctors' education includes ACP communication skills.
authors.affiliation: Division of Palliative Medicine, Department of Oncology and Department of Internal Medicine, University of Calgary, Alberta, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Simon
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Pat
authors.initials: P
authors.lastname: Porterfield
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Shelley Raffin
authors.initials: SR
authors.lastname: Bouchal
authors.affiliation: Clinical Evaluation Research Unit, Department of Medicine, Kingston General Hospital, Kingston, Ontario, Canada Departments of Community Health and Epidemiology and Medicine, Queens University, Kingston, Ontario, Canada.
authors.forename: Daren
authors.initials: D
authors.lastname: Heyland
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003144:Communication Barriers; D003657:Decision Making; D005190:Family; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011446:Prospective Studies; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D019452:Terminally Ill
keywords: Advance Care Planning; Communication; Critical Illness; Goals Of Care; Qualitative Research