Table 3

Barriers and facilitators related to engagement in ACP

Patient related		HCP related	System related
Barriers	Insufficient patient knowledge about their own disease.23 25 29 32 38	Perceived hesitance of HCPs to discuss preferences and engage in ACP.21 23	Ethos of ‘cure at all costs’ in.32
	Unpredictable disease course and difficult prognostication.19 25 27 31 32	HCP’s perceived fear of taking away patients’ hope.19 25	Perceived HCP’s time constraints. 23 27 29 32 34 35 38
	Perceived patient hesitation for considering and discussing treatment preferences.19 25 27		Lack of organisational support and formal training on communicating end-of-life care options.19 22 32 37 38
			Lack of continuity and coordination of care including uncertainty on whose responsibility it is to initiate and follow-up on ACP discussions.21 25 29 30 32 38
Facilitators	Increased patient knowledge on terminal nature of their disease.28 33	Advanced stage of disease.23 25 27 29	Patient initiation of ACP (as experienced by HCPs),31 HCP initiation of ACP (as experienced by patients).23 25 28
	Patients accepting their disease, increasing readiness to discuss end-of-life care.27 31 33	Identification of the right moment and setting to engage in an ACP discussion.28 31 32	Implementation of trigger points to discuss ACP.32
	Patient worry to become a burden for the family.23 25	HCPs’ experience with care for patients at the end of life/ with lung diseases.23 25 34	Continuity of care, including good HCP–patient relationship.23 25 31 33 34
	Patient experience with end of life.23 33 35