Table 1

Barriers to ACP

Patient factorsProfessional factorsSystem 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.