Barriers to and enablers of advance care planning with patients in primary care Survey of health care providers

Objective To identify barriers to and enablers of advance care planning (ACP) perceived by physicians and other health professionals in primary care. Design Cross-sectional, self-administered survey. Setting Ontario, Alberta, and British Columbia. Participants Family physicians (n = 117) and other health professionals (n = 64) in primary care. Main outcome measures Perceived barriers relating to the clinician, characteristics of patients, and system factors, rated on a 7-point scale from 0 (not at all) to 6 (an extreme amount), and enablers reported using an open-ended question. Results Between November 2014 and June 2015, questionnaires were returned by 72.2% (117 of 162) of family physicians and 68.8% (64 of 93) of the other health professionals. Physicians rated insufficient time, inability to electronically transfer the advance care plan across care settings, decreased interaction with patients near the end of life owing to transfer of care, and patients(difficulty understanding limitations and complications of treatment options as the highest barriers. Other health professionals additionally identified their own lack of knowledge and difficulty accessing the physician as barriers. Themes identified as enablers included greater public engagement, clinician attitudes, creating capacity for clinicians, integrating ACP into practice, and system and policy supports. Conclusion In primary care, there are barriers to engaging patients in ACP at the patient, provider, and system levels that could potentially be addressed through the informed development of multifaceted interventions.