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

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.