Table 2.

Mean importance of barriers to ACP among 112 primary care physicians and 58 nurses and other health professionals in primary care: Items were rated on a 7-point scale from 0 (not at all) to 6 (an extreme amount) and are listed in descending order of magnitude of mean overall rating within each section.

BARRIERSALL, MEAN (SD)PHYSICIANS, MEAN (SD)OTHER HEALTH CARE PROFESSIONALS, MEAN (SD)P VALUE
Barriers related to own role
  • My difficulties with defining the right moment to engage patients in ACP

2.5 (1.5)2.4 (1.4)2.8 (1.7).32
  • My lack of knowledge about the legal status of ACP documents in the province

2.4 (1.7)1.9 (1.4)3.4 (1.9)< .001
  • My difficulties in dealing with uncertainty of prognosis for patients with chronic illness

2.2 (1.4)1.9 (1.3)2.7 (1.6).05
  • My lack of knowledge about ACP and its relationship to advance directives and goals-of-care discussions

2.1 (1.6)1.7 (1.3)3.1 (1.7)< .001
  • My doubts about the availability or accessibility of ACP documents when they are needed in the future to make medical decisions

2.0 (1.5)2.1 (1.5)1.9 (1.5).35
  • My lack of knowledge about how to elicit values, beliefs, and preferences related to end-of-life care

1.9 (1.4)1.6 (1.1)2.7 (1.7)< .001
  • My difficulties in dealing with patients’ changing preferences for medical treatments at the end of life

1.8 (1.3)1.6 (1.2)2.3 (1.6).17
  • My having to deal with the emotional effects of ACP conversations with patients

1.6 (1.4)1.4 (1.2)2.0 (1.6).07
  • My belief that other health care professionals are better positioned to initiate ACP

1.6 (1.8)1.0 (1.3)2.7 (2.1)< .001
  • My belief that advance care plans are too simplified for complicated medical scenarios

1.4 (1.3)1.3 (1.2)1.5 (1.4).70
  • My fear that these conversations will diminish hope in patients with serious illness

1.2 (1.2)1.2 (1.2)1.3 (1.4).83
  • My belief that physicians are better positioned to do ACP

NANA1.0 (1.3)NA
  • My belief that patients should initiate this type of discussion

0.9 (1.3)0.8 (1.1)1.3 (1.5).11
  • My fear that ACP will negatively affect my relationship with patients

0.8 (1.0)0.8 (1.0)0.8 (0.8).43
  • My belief that it is my job to cure people

0.6 (1.2)0.6 (1.2)NANA
Barriers related to physicians as perceived by allied health professionals
  • Physicians’ lack of time to have conversations with patients and families

NANA3.3 (2.4)NA
  • Insufficient access to or availability of physicians to help with ACP (eg, too busy)

NANA3.2 (2.2)NA
  • Physician not in agreement with me about when to initiate ACP

NANA2.6 (2.7)NA
  • Physicians’ desire to avoid conflict or strong emotions that might arise during discussions about goals of care

NANA2.4 (2.7)NA
  • Physicians’ lack of communications skills

NANA2.1 (2.3)NA
Barriers related to patient characteristics
  • Patients’ difficulty understanding the limitations and complications of life-sustaining therapies (mechanical ventilation, CPR, vasopressors, etc) at the end of life

3.1 (1.3)3.1 (1.3)3.1 (1.3).45
  • Patients’ lack of understanding about how treatment decisions are made at the end of life

3.0 (1.4)2.9 (1.4)3.1 (1.5).88
  • Incapacity of patient because of diminished consciousness or dementia or other cognitive disability

2.9 (1.6)2.8 (1.6)3.1 (1.6).80
  • Patients think ACP is not relevant to them because they are too healthy right now

2.8 (1.4)2.7 (1.4)3.0 (1.4).81
  • Patients’ fear of upsetting their families by discussing the topic

2.7 (1.4)2.5 (1.4)3.0 (1.4).66
  • Patients’ difficulty accepting their poor prognoses

2.6 (1.2)2.6 (1.2)2.5 (1.2).56
  • Patients not understanding or misinterpreting my reasons for bringing up the topic

2.3 (1.3)2.3 (1.3)2.4 (1.4).53
  • Family unwillingness to support me in engaging the patient in ACP discussions

2.3 (1.4)2.1 (1.4)2.6 (1.4).22
  • Patients’ strong religious convictions

1.8 (1.4)1.6 (1.3)2.3 (1.7).26
Barriers related to the health care system or external factors
  • Insufficient time during scheduled appointments to deal with this topic

3.8 (1.7)4.3 (1.4)2.8 (1.8)< .001
  • Inability to electronically transfer patients’ advance care plan to acute care

3.5 (1.8)3.4 (1.8)3.7 (1.9).26
  • Decreased interaction with my patients near the end of life owing to transfer of care to specialists or others

3.1 (1.7)3.1 (1.7)3.2 (1.6).96
  • Patients getting different messages from the family physician and the other specialists involved in the patient’s care

2.8 (1.5)2.7 (1.5)3.0 (1.6).82
  • Limited capacity to honour patients’ expectations for care that arise from ACP discussions

2.6 (1.5)2.6 (1.4)2.8 (1.6).54
  • Lack of ready access to forms and resources for patients

2.5 (1.6)2.6 (1.7)2.5 (1.6).40
  • Insufficient access to or availability of other health care professionals (social workers, nurses, or others) to help with ACP

2.4 (1.7)2.5 (1.7)2.4 (1.7).95
  • Lack of financial remuneration for ACP

2.1 (1.9)2.1 (1.9)NANA
  • ACP—advance care planning, CPR—cardiopulmonary resuscitation, NA—not applicable.