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Table 2 Themes and Illustrative Quotes

From: Exploring patient-reported barriers to advance care planning in family practice

 

Theme

Illustrative Quotes

Across all three questions

I’m too young/too healthy for ACP

Did not see this as necessary, it’s a bit soon. I am only 80!”

“I feel that I am too young for making those types of decisions”

“not a priority as a healthy person”

“I am not at that point in my life. If I was diagnosed with a terminal disease, then I would talk with him”

Topic is too emotional

“it’s a little frightening to talk about dying”

“sad emotional topic”

“causing emotional pain to family”

“Scares me; it is very negative and would depress me”

ACP is the MD’s responsibility:

“If a doctor wanted to talk to me about the end of life, it would not be hard for me to do”.

“He would have to suggest the discussion; MD should bring it up”

“I would not want my family making medical decisions at the end of my life”

Relating only to discussions with Family Physicians

Fear of negative impact on relationship with MD

I may be influenced to sway my thoughts”.

“Not knowing if his beliefs and values are the same as mine”

“I am not sure that my doctor and I totally agree on treatments”

“I don’t want to be unduly influenced by him”

Not enough time in appointments

“do not allow for an in depth conversation about something that is not happening now or may not ever happen. Appointments are too short”.

“Doctor is always too busy. I feel I will impose on his time to talk about this when he has other patients waiting”.

“Family doctors are busy people and I would not consider it appropriate to ‘visit’ and discuss a broad topic like end of life”

Relating only to discussions with family members

Concern about family dynamics

“I don’t want arguments arising”

“I don’t trust them very much to leave this kind of decision to them”

Relating only to general questions about ACP discussions with anyone

It’s not a priority

“[I’m]too preoccupied”

“Though about it but just haven’t acted on it basically”

I don’t know enough about ACP

“Did not know about advance care planning; I think my family will know what to do”.