Background Taiwan enacted Patient Right to Autonomy Act in 2019, making advance care planning (ACP) a legally-binding nature. Healthcare providers’ attitude and belief on end-of-life issues discussion for cancer patients would influence their ACP delivery. However, many healthcare providers are confused about the relevant policy and regulation, resulting in poor service uptake in practice. We aim to explore the healthcare providers’ attitude and understanding on ACP for cancer patients in Northern Taiwan.

Methods Qualitative secondary analysis is adopted as study design. We applied thematic analysis and dual coding for fifteen narratives derived from a qualitative primary study regarding palliative care decision-making among advanced cancer patients, their families and healthcare staff. We included perspectives from four physicians, four nurses, three case managers, one medical social worker, one psychologist, one chaplain and one volunteer at a hospice and palliative care unit in a tertiary hospital.

Result Medical professionals reported two dilemmas that they are currently facing: (1) They found that patients generally did not understand ACP, causing them often encounter difficulties in discussions and spend extra time explaining; (2) Some medical personnel mentioned that the division of labor in the medical team was not clear as the doctors had different preference and understanding on treatment, which caused other members felt confused and challenging to cooperate.

Conclusion We learn that different attitude of medical personnel would make great influence to patients’ care, in particular regarding end-of-life care decision- making. Therefore, we suggest: (1) The media or advertisements can be used to promote ACP to general public; (2) Device a detailed procedure for the decision process, and establish regulations for relevant participants. These should be considered while developing a hospital-based ACP program for cancer patients and their family caregivers.