• Lauren Fanta and Jill Tyler.
• University of South Dakota Sanford School of Medicine.
• S D Med. 2017 Jul 1; 70 (7): 303-309.

BackgroundNumerous studies have confirmed the importance of advance care planning. Despite the benefits of directed end-of-life discussions, a variety of barriers including discomfort with the topic, physician ideology, lack of time and reimbursement, delaying discussions, and lack of training impede physicians from facilitating these crucial conversations with their patients. This study aims to understand physicians' perceptions to additional barriers to advance care planning with patients and their families.MethodsInterviews with 19 practicing physicians (seven women and 12 men). Their perceptions were noted in interviews that were audiotaped, transcribed, and analyzed (n = 19).ResultsPhysicians continue to face barriers to advance care planning as well as struggle with additional challenges such as difficulty with families, lack of patient education, inconsistencies and accessibility of advance directive documents, and lack of physician-physician communication or agreement in care. Further analysis reveals contradictions regarding physician comfort level and the role of primary care. These results reveal the complexity of providing medical care and the continued need for improvements in physician-patient communication about end-of-life care.ConclusionsComplex challenges in communication impede the delivery of successful end-of-life experiences for patients and their families. With improvements in the practices of advance care planning, many of these challenges can be removed - enabling individuals to remain in control as they near the end of their lives and preventing unnecessary pain and suffering on behalf of the patient and family.

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