Factors influencing engagement in advance care planning in the community: A mixed-research synthesis

BACKGROUND: The development of innovative Advance Care Planning (ACP) health behaviour change interventions for adults (≥50 years old) in the community should be informed by a findings synthesis. The objectives of this review were to (a) identify stakeholders' perspectives on facilitators and barriers to ACP behaviours and (b) map these factors across the Capability, Opportunity, and Motivation dimensions of behaviour (COM-B model). METHODS: This hybrid mixed-research synthesis followed a published protocol. Content analysis was applied to the results sections of the included studies. Data transformation and triangulation processes underpinned findings integration (4,5). RESULTS: The review included 117 records and studies recruited patients (62%), service providers (29%), and trusted others (9%). ACP behaviours were ACP as a general concept, (41%), communication (28.7%), documentation (22%), decision-making (5.3%), or surrogate appointment (3%). Ten categories of influencing factors were identified, ranked according to frequency of reporting. They included Connectedness, Psychological Factors, Metapreferences, Service Provision, Temporality, Sociodemographic Characteristics, Literacy, Resources, Experience, and Macro-Level Factors. Their sub-categories (52 in total) were mapped across the COM-B model. The most frequently reported Motivation sub-categories were Comfort and Readiness (n = 78), Actors and Roles Requirements (n = 56), and Perceptions and Beliefs (n = 45). The Opportunity dimension included Communication and Understanding (n = 43), Effect of the Other (n = 42), and Involvement and Collaboration (n = 41). The top Capability sub-category was ACP literacy (n = 43). DISCUSSION: The triangulation of stakeholders' perspectives facilitated identification a complex array of factors influencing ACP behaviours. Their mapping across the COM-B model informed future research, policy, and ACP intervention development. KEY MESSAGES: • Stakeholders’ engagement in ACP behaviours is influenced by a complex array of factors, with the majority of them falling into the categories of motivation and opportunity. • Future ACP interventions design need to build on this learning and develop strategies and policies that support meaningful stakeholders’ engagement in ACP activities, including their collaboration.