Table 2 Barriers and facilitators for pACP from the perspective of healthcare professionals working in paediatric oncology
Barriers | Facilitators |
|---|---|
- ACP is not yet performed structurally - conducting ACP is deemed difficult - lack of time during standard consultations - insecurity about the timing of such conversations - too little training to perform ACP conversations - lack of structure in the way the medical team works hinders involving the other team members - afraid of not being able to deal with the family’s emotions - afraid of losing the parents’ trust when discussing certain themes with the patient - perceived lack of parental readiness to talk about ACP themes - because the child’s situation can change rapidly, professionals do not always see an added value regarding starting a conversation on their current or future preferences - the idea that you are only able to discuss ACP themes when the patient or parent him- or herself opens up the conversation, or that it is necessary to perform ACP in an indirect way to almost hide what they mean, is illustrated by this quote from a participant: “it’s an art isn’t it, to try and bring it up in a way that they don’t notice you want to talk about it.” - the idea that, in the oncological target group, ACP is less needed and is done sufficiently due to the relatively clear illness trajectory compared to other groups with complex chronic conditions | - agreement that conducting ACP conversations is important, and that it is essential to start talking about ACP themes rather early in the illness trajectory - the view of ACP as a broader process and not only with the end goal of completing an advance directive - the belief that ACP would lead to more involvement of the adolescent in their treatment, and that the family is better informed about the different potential trajectories - the belief that ACP will give the family peace of mind, as they will have discussed ACP themes and thought about different potential trajectories, making it easier to make difficult decisions when needed - consensus about the criteria the facilitator performing the BOOST pACP conversations should adhere to: have experience with talking with adolescents with cancer, have good communication skills and have sufficient time to conduct the conversations |