Table 2

Access to doctor and ACP resources influencing engagement in ACP

Element of accessFacilitator (F) or barrier (B)Illustrative quote
Access to doctor and/or other healthcare providers(F) Organised access to GP/doctors in hospital or other healthcare providers willing to engage in ACP‘If there was some way to be given a number to call at a convenient time than to wait for them to show up.’ (FM)
‘We used to have family meetings at X [previous living location] including social workers, MDs, RNs. We discussed where we are going with treatment and prognosis. It would be helpful to schedule a family meeting to discuss.’ (FM)
(B) Lack of access to GP or lack of clarity as to who to approach in hospital‘My GP moved 20 km away and it is too difficult and too expensive to get there. I need a new GP.’ (P)
‘I haven't seen my family doctor and I haven't brought this up in hospital. I also don't know who my doctor is.’ (P)
‘Nurses are more available but not the ones who I can talk to about this.’ (FM)
‘I don't usually go to the GP with her.’ (FM)
Access to information about ACP presented in a variety of ways (eg, written information; public advertising; normalising participation in ACP)(F) Timely access to information on ACP, related documents and treatment options‘Information available to address these issues to be given out to family. More info about CPR, palliative care and other end-of-life treatment options before the patient is too ill.’ (FM)
‘Handout a routine form to normalise it that can be completed by patient and family and not in the presence of a doctor who I don't know.’ (P)
‘Our daughter's father-in-law died. We were aware of the living will that he had, then seeing the commercial on TV made us talk about it; we wanted to make plans to make it easier for our daughter to discuss with health care members.’ (FM)
(B) Lack of timely information on ACP, related documents or treatment options; information presented without opportunity for discussion‘I need to have this all written out; I am a visual person.’ (P)
‘We've been trying to figure out exactly which form and get the family together to discuss.’ (P)
‘The doctor instigated the discussion by giving the patient forms but family did not take part in the discussion.’ (FM)
Access to a ‘seamless’ ACP system to provide continuity of care(F) Clarity as to roles of different organisations and professionals and the necessary tools to assist person in sharing ACP across the system‘Would be good to carry a card in the wallet with GOC [Goals of Care] and ACP.’ (P)
‘If family doctor remains involved when patient is in hospital because he [sic] knows patient best and hospital doctors have to relearn patient's history which is frustrating to all. GP should be part of dialogue.’ (FM)
(B) Lack of clarity regarding what constitutes ACP and the roles of various organisations; lack of a protocol or system infrastructure for ACP‘Everything is arranged through the Coop Memorial Society [a funeral director]—no further action required.’ (FM)
‘No one at hospital admission wanted or knew what to do with the ACD [Advance care directive] that I brought in…’ (P)
  • ACP, advance care planning; CPR, cardiopulmonary resuscitation;FM, family; GP, general practitioner; P, patient..