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Advance care planning: identifying system-specific barriers and facilitators.

N A Hagen1, J Howlett2, N C Sharma2

  • 1Departments of Oncology, Clinical Neurosciences, and Medicine, University of Calgary, Calgary, AB;

Current Oncology (Toronto, Ont.)
|August 25, 2015
PubMed
Summary

Identifying barriers to advance care planning (ACP) is crucial for healthcare systems. This study developed a simple process to find local barriers and facilitators for ACP uptake and create mitigation strategies.

Keywords:
Advance care planninggoals of care designationknowledge translation

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Area of Science:

  • Health Services Research
  • Knowledge Translation
  • Healthcare Management

Background:

  • Advance care planning (ACP) is vital in modern healthcare.
  • Identifying local barriers and facilitators to ACP uptake in complex health systems remains challenging.
  • Developing targeted strategies to overcome these barriers is essential for improving ACP implementation.

Purpose of the Study:

  • To prospectively identify system-specific barriers and facilitators to advance care planning (ACP) uptake.
  • To develop and test a process for identifying local barriers and enablers within a multi-sector health system.
  • To generate specific strategies for mitigating identified barriers to ACP.

Main Methods:

  • A survey of healthcare opinion leaders in Alberta, Canada, was conducted.
  • The survey utilized published literature and the Michie Theoretical Domains Framework.
  • Semi-structured discussions with key informants explored local barriers and facilitators further.

Main Results:

  • 58% of surveyed opinion leaders returned the survey, identifying key system-specific barriers.
  • Barriers included insufficient public engagement, conflicting health initiatives, and lack of infrastructure.
  • Discussion groups identified actionable approaches to mitigate specific barriers to ACP.

Conclusions:

  • Implementing change in complex, multi-sector healthcare systems is challenging.
  • Identifying system-specific barriers and facilitators is key for successful knowledge translation and innovation uptake.
  • A simple, inexpensive process effectively identified local barriers and enablers for ACP, leading to targeted mitigation strategies.