# Patient perceptions of advance care planning within primary care: a systematic review of facilitators and barriers

## TL;DR

This review explores what helps or hinders patients from engaging in advance care planning discussions with their primary care doctors.

## Contribution

The study systematically identifies and categorizes patient-related, professional, and conversation-specific barriers and facilitators to advance care planning in primary care.

## Key findings

- Barriers and facilitators are grouped into three themes: professional factors, patient factors, and features of the conversation.
- Key facilitators include strong patient-professional relationships, sufficient time for discussions, and professional training.
- Public awareness and a balance between standardization and individualized care are recommended to improve advance care planning.

## Abstract

Advance care planning is a key aspect of palliative care and aims to establish patient preferences for future care, benefiting patients and their families. Palliative care, including advance care planning, is often provided by primary care physicians. Levels of advance care planning, however, remain low internationally. We aimed to conduct a systematic literature review to understand the barriers and facilitators encountered by patients when considering advance care planning conversations within the primary care setting.

Five electronic databases (Ovid MEDLINE, PubMed, PsycINFO, CINAHL and Scopus) and grey literature were searched in April 2025. Quantitative and qualitative data were extracted and synthesised using a convergent, integrated approach. The Mixed Methods Appraisal Tool was used to assess study quality.

From 2495 articles, 48 studies were included. Barriers and facilitators can each be categorized into three themes, with further subthemes: 1) Professional factors, which encompassed the relationship between patient and healthcare professional, the skills and attributes of the healthcare professional, and the specific role of the healthcare professional in the advance care planning process; 2) Patient factors, including perceptions of self, family role, personal and religious views of advance care planning, and personal characteristics; 3) Features of the advance care planning conversation.

To enhance advance care planning uptake, there should be protection of relationships between healthcare professional and patient, adequate time for face-to-face conversations, and relevant training for healthcare professionals. More widely, increasing public awareness of these topics is vital. It is essential to balance standardisation to encourage and support these conversations, whilst maintaining an individualised approach.

The online version contains supplementary material available at 10.1186/s12875-025-03028-0.