Table 2 Challenges and barriers to ACP

Identifying the best time and most appropriate person to introduce ACP issues to patients

Lack of resources (including time and end-of-life services) with which to meet patients' preferences and support family carers

Managing differences in staff understandings of ACP in the wider health care team

Lack of public and patients' awareness about ACP and other end-of-life issues

Managing the emphasis on instructional directives and the drive to bureaucratize ACP practice

Taboos and fears about death and dying among public and patients

Documentation and communication of ACP discussions across health care systems

Managing the potential conflict or difference between patient and family carers' views