• Cheryl Tilse, Lindy Willmott, Jill Wilson, Rachel Feeney, and Ben White.
• School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia.
• Palliat Med. 2021 Dec 1; 35 (10): 1889-1896.

BackgroundFor a patient's legal right to make end-of-life treatment decisions to be respected, health care practitioners, patients and their substitute decision-makers must know what rights exist and how to assert them (or support others to assert them). Yet very little is known about what enhances or obstructs the operationalization of legal rights from the perspective of patients, family members and substitute decision-makers.AimTo explore barriers and facilitators to the operationalization of rights in end-of-life decision-making from the perspectives of terminally-ill patients and family members and substitute decision-makers of terminally ill patients in Australia.DesignSemi-structured interviews (face to face and telephone) with patients, family or substitute decision-makers experienced in end-of-life decision-making completed between November 2016 and October 2017. A thematic content analysis of interview transcripts.Setting/ParticipantsPurposive sampling across three Australian states provided 16 terminally-ill patients and 33 family and/or substitute decision-makers.ResultsBarriers and facilitators emerged across three overlapping domains: systemic factors; individual factors, influenced by personal characteristics and decision-making approach; and communication and information. Health care practitioners play a key role in either supporting or excluding patients, family and substitute decision-makers in decision-making.ConclusionIn addition to enhancing legal literacy of community members and health practitioners about end-of-life decision-making, support such as open communication, advocacy and help with engaging with advanced care planning is needed to facilitate people operationalizing their legal rights, powers and duties. Palliative care and other support services should be more widely available to people both within and outside health systems.

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