Abstract

Background: One of the main objectives of advance care planning (ACP) programmes is to provide end-oflife care in accordance with patient choices. Despite the hope, several studies have failed to demonstrate how ACP increases patients' chances of obtaining end-of-life care that is in line with their wishes. Uncertainty persists on the causes of and obstacles to providing end-of-life (EOL) care in accordance with individuals' recorded ACP wishes. We sought to comprehend health care professionals' (HCPs) perceived difficulties in providing end-of-life care accordance with patients' documented ACP wishes using data from Singapore's national ACP programme assessment.

Methods: We held 21 focus group talks and 1 in-depth interview with HCPs participating in Singapore's national ACP programme implementation in public hospitals, public primary care clinics, and nursing homes. These HCPs had received training in ACP facilitation and advocacy. ACP leaders/champions, ACP facilitators, nursing home administrators/administrative staff, and type of institution (hospital, primary care clinic, and nursing home) were taken into account while stratifying the data collection. There were 1 to 8 people in each topic. Discussions were audio recorded, verbatim transcribing, and accuracy confirmed. Using the Nvivo 11 thematic analysis framework, we examined the data.

Results: A total of 107 people took part in one of the conversations, and 35% of them were doctors. In order to deliver end-of-life care in accordance with patients' recorded ACP choices, we conceptualised five themes: The ACP does not take into account patients' changing preferences or medical conditions. There are also resources lacking in the health system to support and honour patient preferences, obstacles to retrieving ACP documents, and rigidity in ACP documentation.

Conclusions: Future ACP programmes should involve physicians and families for ongoing conversations, frequently update patients' ACP documents, involve clear and well-resourced plans for implementing patients' preferences, and incorporate adaptable electronic systems to record ongoing ACP conversations. Conclusions: Providing end-of-life care consistent with preferences may not always be possible.