Background Advance care planning (ACP) is the process of individuals discussing and recording personal values, beliefs, and preferences so that, in the event they lose capacity, a person receives care consistent with their preferences. Despite Department of Health recommendations, national rates of documentation for people with cancer are only 27%, well below the target of 50%. The aim of this study was to identify barriers to ACP across the care pathway, at a world-leading comprehensive cancer centre.

Methods A mixed methods design was used to: (1) identify ACP touchpoints across the care pathway and (2) explore barriers and enablers of ACP. Twenty-two key stakeholders were recruited to the study including staff, and consumers. Two focus groups explored touchpoints and opportunities for ACP across the care pathway, to develop a process map. The ‘action, actor, context, target, time’ (AACTT) Framework was used to specify behaviours. Semi-structured interviews explored barriers and enablers at each touchpoint. The TDF was used to guide the interviews and analysis.

Results Process maps representing differing perspectives between consumers and hospital staff (medical, nursing, allied health, and administrative staff) identified 20 ‘actions’ associated with ACP across the care pathway. The AACTT analysis clarified that 5 staff-roles were responsible for performing ACP-related behaviours. Barriers included perceived emotional consequences for patients and inadequate digital infrastructure for accessing ACP documentation at the point of care.

Conclusion Using a theory-based approach, barriers for ACP across the care pathway were identified. To improve ACP uptake in oncology settings, interventions should target these barriers.