Perspectives of Palliative Care Physicians on Advance Care Planning: Key Determinants and Necessary Tool Components
Keywords:
advance care plan, palliative care, palliative care specialistsAbstract
This qualitative research aimed to explore the experiences, and understand the factors, influencing the decision-making process for advance care planning and identify key components of the advance care planning form from the perspectives of 12 palliative care physician experts, all of whom are certified in Family Medicine with a subspecialty in Palliative Care with each having at least two years of experience in providing palliative care services. In-depth interviews lasting 45–60 minutes were conducted between September 2024 and May 2025 using a semi-structured interview guide developed from a literature review with an index of item-bjective congruence (IOC) of 1. Data were analyzed using thematic analysis.
The results revealed four key themes regarding both facilitating and hindering factors influencing advance care planning decisions: 1) Knowledge and Information Access, 2) Personal Autonomy, 3) Cultural and Spiritual Barriers, and 4) Healthcare system readiness. In addition, from the experts' perspectives, the components of the advance care planning documentation could be divided into two main groups: 1) Essential components for completeness – including care goals, decisions regarding life-sustaining procedures, and the designation of a health care proxy; and 2) Recommended components for more effective planning, including patients’ spiritual needs, illness perception and physical care needs, family communication, and relevant social factors. The results of this study can be used as a guideline for healthcare professionals to understand the factors influencing decisions on advance care planning and to initiate appropriate conversations about advance care planning with palliative care patients. Moreover, the results can be applied to the development of advance care planning forms based on the components recommended by specialists, in order to facilitate advance care planning with patients and families, while considering the factors affecting patients’ decisions and the key issues that should be discussed for joint health care planning.
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