TY  - JOUR
T1  - Experiences of Advance Care Planning Among Patients, Family Caregivers, and Healthcare Providers: A Qualitative Study
A1  - Nora Schneider
A1  - Tobias Frank
A1  - Julia Kramer
JF  - Journal of Integrative Nursing and Palliative Care
JO  - J Integr Nurs Palliat Care
SN  - 3006-5550
Y1  - 2026
VL  - 7
IS  - 1
DO  - 10.51847/Zv5HsDXVw5
SP  - 16
EP  - 29
N2  - Advance care planning (ACP) helps ensure that medical care respects patients’ personal preferences while enhancing the quality of end-of-life care. However, utilization remains restricted and is routinely prompted by medical emergencies, especially within collectivist cultures where family interconnectedness and emotional resilience influence engagement. There is still limited empirical research exploring how patients, their relatives, and clinicians experience ACP within non-Western medical environments. To investigate how patients, family caregivers, and healthcare practitioners experience and navigate engagement with ACP within a palliative care setting in Thailand. A qualitative investigation employing reflexive thematic analysis. A university-affiliated hospital located in Bangkok, Thailand. Thirty individuals in total: 10 patients living with life-limiting conditions, 10 family caregivers, and 10 healthcare professionals. Semi-structured interviews were conducted at a palliative care facility between January and October 2025. These interviews were transcribed word-for-word, translated utilizing meaning-based equivalence, and analyzed via an inductive, reflexive thematic approach. Four overarching themes (10 subthemes) framed ACP as a relationally negotiated, culturally contextualized practice. (1) Timing and pathways: emotional states, family dynamics, and organizational systems determined when ACP could occur, which was predominantly during acute clinical crises. (2) Values and visions of a good death: priorities were driven by physical comfort, tranquility, and avoiding becoming a burden, though actualization was restricted by caregiving capacity and limited resources. (3) Communication as relational positioning in ACP: patient engagement was encouraged through compassionate truth-telling and gradual information sharing; final choices were mediated within the family unit; medical doctors generally introduced ACP, whereas nursing staff maintained ongoing interpersonal connection. (4) Structural conditions shaping the possibility of ACP: institutional hierarchies, heavy workloads, insufficient training, and a lack of community support networks impede proactive use, thereby perpetuating reactive approaches. ACP within this setting operates as a relationally mediated practice that relies heavily on the alignment of emotional, familial, and structural readiness. Initializing conversations during a crisis points to a breakdown across these integrated areas rather than mere cultural opposition. Enhancing culturally sensitive communication methods, family-inclusive dialogue, clear multidisciplinary responsibilities, and systemic support could encourage timelier and more continuous ACP conversations. In collectivist medical systems, the implementation of ACP depends on the alignment of emotional, familial, and structural readiness. Absent integrated relational and institutional backing, these dialogues remain driven by medical crises despite a shared desire for a dignified death free of unnecessary burdens.
UR  - https://journalinpc.com/article/experiences-of-advance-care-planning-among-patients-family-caregivers-and-healthcare-providers-a-to0fntzockef2kq
ER  -