Facilitators and barriers to advance care planning programmes targeting older care home residents: a qualitative study

Background. Advance care planning (ACP) is considered to be an integral part of end-of-life care. This study explored the facilitators and barriers of ACP by consolidating the practice experiences of a group of healthcare professionals involved in an outreach end-of-life programme for older people living residential care homes for the elderly (RCHEs). Methods: Fourteen healthcare professionals participated in this qualitative study. They first completed a questionnaire to capture their views on ACP by describing a successful case. Then they took part in a focus group to discuss desired outcomes, facilitators, and barriers of ACP. Thematic analysis was applied to the questionnaire and focus group data. Results: Participants considered ACP a valuable opportunity for older people to express their care preferences. The resultant care plan provides families and care teams a useful reference for treatment decision-making. Facilitators included the collaborative ties among the community geriatric assessment team, RCHE staff, and the families of patients; dedicated and trained staff; and well-informed family members. Barriers included delayed referral, a lack of public acceptance and awareness, and overwhelming routines among healthcare professionals. Conclusions: Our findings underscore the multitude of individual, family, staff, and social factors affecting the dynamic process of ACP. An effective collaborative framework and professional training in communicating with distressed families are required. In addition, enhancing public awareness of comfort care and ACP is crucial.