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BOS2c.003 Facilitators and barriers to stakeholder engagement in advance care planning for older adults in community settings: a mixed-research systematic review
  1. Monika Pilch1,
  2. Victoria Cooper Lunt2,
  3. Anneka Hickey3,
  4. Stephen Thomas1,4,
  5. Catherine Hayes5,
  6. Bartosz Kaminiecki3,
  7. Julia Korpak6 and
  8. Frank Doyle7
  1. 1Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
  2. 2Beaumont Hospital and St Luke’s Radiation Oncology Centre at Beaumont Hospital, Beaumont Hospital, Dublin, Ireland
  3. 3Independent Researcher, Dublin, Ireland
  4. 4Health Policy and Engagement, School of Medicine, Trinity College Dublin, Dublin, Ireland
  5. 5Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Ireland
  6. 6Independent Researcher, The Hague, The Netherlands
  7. 7Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland


Background A systematic synthesis of findings on factors influencing ACP engagement should inform the development of innovative behaviour change interventions. The objectives of this review were to (a) identify all stakeholders` perspectives on facilitators and barriers to engagement in ACP behavioural outcomes among adults (≥50 years old) in community settings and (b) map the influencing factors across the Capability, Opportunity, and Motivation dimensions of behaviour (COM-B model).

Methods The study utilised a hybrid mixed-research synthesis approach and followed a published protocol. Content analysis was applied to the results section of the included studies. A systematic data transformation and triangulation processes underpinned findings integration.

Results The review included 117 records, mainly using qualitative approaches (86.3%). Studies included patients (62%), service providers (29%), and trusted persons/surrogates (9%). The behavioural focus was on the general ACP behavioural outcome (41%), communication (28.7%), documentation (22%), decision-making (5.3%), or surrogate appointment (3%). Ten categories of influencing factors were identified. They were ranked according to frequency of reporting and labelled as: Connectedness, Psychological Factors, Metapreferences, Service Provision, Temporality, Sociodemographic Characteristics, Literacy, Resources, Experience, and Macro-Level Factors. Each category was defined by meaningful sub-categories (52 in total), which were mapped across the COM-B model. The most frequently reported factors within the Motivation dimension of the COM-B were Comfort and Readiness (n=78), Actors and Roles Requirements (n=56), and Perceptions and Beliefs (n=45). The Opportunity dimension included Communication and Understanding (n=43), Effect of the Other (n=42), and Involvement and Collaboration (n=41). The top sub-category within the Capability dimension was ACP literacy (n=43).

Discussion The triangulation of stakeholders` perspectives facilitated identification a complex array of factors that influence engagement in ACP behaviours. Their mapping across the COM-B model pointed directions for future research, policy, and practice. It will also inform the design of an innovative and evidence-based ACP intervention.

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