Barriers and strategies to an iterative model of advance care planning communication

Am J Hosp Palliat Care. 2015 Dec;32(8):817-23. doi: 10.1177/1049909114541513. Epub 2014 Jul 2.


Background: Early and repeated patient-provider conversations about advance care planning (ACP) are now widely recommended. We sought to characterize barriers and strategies for realizing an iterative model of ACP patient-provider communication.

Methods: A total of 2 multidisciplinary focus groups and 3 semistructured interviews with 20 providers at a large Veterans Affairs medical center. Thematic analysis was employed to identify salient themes.

Results: Barriers included variation among providers in approaches to ACP, lack of useful information about patient values to guide decision making, and ineffective communication between providers across settings. Strategies included eliciting patient values rather than specific treatment choices and an increased role for primary care in the ACP process.

Conclusions: Greater attention to connecting providers across the continuum, maximizing the potential of the electronic health record, and linking patient experiences to their values may help to connect ACP communication across the continuum.

Keywords: advance care planning; continuity of care; electronic health record; goals of care; patient preference; primary health care.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Advance Care Planning*
  • Decision Making*
  • Electronic Health Records
  • Health Communication*
  • Hospitals, Veterans
  • Humans
  • Interviews as Topic
  • Primary Health Care