Introduction Advance care planning is recognised as optimal in promoting patient autonomy and shared decision making, aiming to improve quality of care at end of life. Healthcare assistants are an integral part of the multi-disciplinary team, playing a pivotal role in the provision and application of advance care planning, though they are largely unrecognised and unsupported in this role.

This is the first known paper studying the role of the HCA in HP and ACP. It has implications for HP policy and practice, identifying the need for further research in the role of the HCA in providing high quality end of life care.

Aims In this study we aimed to explore health care assistants’ beliefs, intentions, and behaviour regarding advance care planning via the Theory of Planned Behaviour framework with palliative care patients and their caregivers in the community

Method We conducted a qualitative study using semi-structured interviews. From a potential pool of 95 HCAs employed in Northern Ireland, a purposive sample of 9 agreed to take part. Interviews were undertaken online, transcribed, and subject to thematic analysis and informed by the Theory of Planned Behaviour coding process.

Results Nine health care assistants participated. Analysis revealed, healthcare assistants believed they were best placed to hold intimate advance care planning conversations, due to the personal relationship they built with patients and families, however their role was believed to be undervalued and unseen in policy and practice. Normative beliefs identified a lack of role definition and boundaries in advance care planning within the multi-disciplinary team.

Participants behavioural intentions were to support patients and families, through barriers relating to role definition and boundaries created uncertainty.

Conclusion Findings of this study inform our understanding of the role of the healthcare assistants in promoting and implementing advance care planning conversations. Results reflect previous research which indicate key barriers in the lack of role clarity for healthcare assistants to promoting advance care planning. Overall, the findings highlight the need for recognition to be given to the healthcare planning role and interventions to be developed to expand this role.

Impact We believe this paper demonstrates the need for enhance research in this area, nationally. As well as the development an ACP education programme for HCAs and clear guidelines and definition surrounding ACP and the HCAs role.

Having a trained and supported HCA workforce would enable enhanced use of meaningful ACP conversations, enabling MC to provide an enhanced, personalised, holistic end of life care service and supporting patients and families.