An integrative review of stakeholder views on Advance Care Directives (ACD)

barriers and facilitators to initiation, documentation, storage, and implementation

Bronwyn Hemsley*, Jacqueline Meredith, Lucy Bryant, Nathan J. Wilson, Isabel Higgins, Andrew Georgiou, Sophie Hill, Susan Balandin, Shaun McCarthy

*Corresponding author for this work

Research output: Contribution to journalReview article

1 Citation (Scopus)


Objective: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. Method: An integrative review of 93 studies, analysed according to their content themes. Results: Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. Conclusions: There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. Practice Implications: It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients’ end-of-life care decisions.

Original languageEnglish
Pages (from-to)1067-1079
Number of pages13
JournalPatient Education and Counseling
Issue number6
Publication statusPublished - 1 Jun 2019



  • Advance Care Directive
  • Advance care planning
  • End-of-life care
  • Patient views

Cite this