title: Barriers and strategies to an iterative model of advance care planning communication.
abstract: BACKGROUND
  Early and repeated patient-provider conversations about advance care planning (ACP) are now widely recommended. We sought to characterize barriers and strategies for realizing an iterative model of ACP patient-provider communication.
  
  
  METHODS
  A total of 2 multidisciplinary focus groups and 3 semistructured interviews with 20 providers at a large Veterans Affairs medical center. Thematic analysis was employed to identify salient themes.
  
  
  RESULTS
  Barriers included variation among providers in approaches to ACP, lack of useful information about patient values to guide decision making, and ineffective communication between providers across settings. Strategies included eliciting patient values rather than specific treatment choices and an increased role for primary care in the ACP process.
  
  
  CONCLUSIONS
  Greater attention to connecting providers across the continuum, maximizing the potential of the electronic health record, and linking patient experiences to their values may help to connect ACP communication across the continuum.
authors.affiliation: Oregon State University, Corvallis, OR, USA VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA sangeeta.c.ahluwalia@oregonstate.edu.
authors.forename: Sangeeta C
authors.initials: SC
authors.lastname: Ahluwalia
authors.affiliation: Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Bekelman
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Alexis K
authors.initials: AK
authors.lastname: Huynh
authors.affiliation: Portland VA Medical Center, Portland, OR, USA Oregon Health and Science University, Portland, OR, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Prendergast
authors.affiliation: Lebanon VA Medical Center, Lebanon, PA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Shreve
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Karl A
authors.initials: KA
authors.lastname: Lorenz
mesh_terms: D032722:Advance Care Planning; D003657:Decision Making; D057286:Electronic Health Records; D058015:Health Communication; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D011320:Primary Health Care
keywords: advance care planning; continuity of care; electronic health record; goals of care; patient preference; primary health care