Barriers to ACP
| Patient factors | Professional factors | System factors |
| Insufficient knowledge about health situation10 | Hesitance to discuss possible future deterioration with patients,10 especially when they appear well11 | Focus on treatment and cure10 11 |
| Unpredictable course of disease and difficult prognostication10 | Fear to take away hope10 12 | Lack of coordination and structured approach to ACP10 |
| Hesitance to consider/discuss treatment preferences,10 12 for example, due to anxiety and denial11 | Lack of communication training10 11/skills12 | Unclear responsibilities for ACP initiation10 12 |
| Expectation that doctors initiate ACP11 | Time constraints10 11 | Lack of accessibility of documented goals and preferences11 |
| Difficulties to find the right moment to initiate ACP11 12 | Limited resources12 |
ACP, advance care planning.