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Background <p>Advance care planning (ACP) aligns care with patients’ values and improves end-of-life outcomes. Yet uptake remains limited and frequently crisis-triggered, particularly in collectivist contexts where family interdependence and emotional tolerance shape participation. Empirical understanding of how ACP is experienced across patients, families, and healthcare providers in non-Western settings remains limited.</p> Objective <p>To explore how patients, family caregivers, and healthcare providers experience and negotiate participation in ACP within a Thai palliative care context.</p> Design <p>Qualitative study using reflexive thematic analysis.</p> Setting <p>A university hospital in Bangkok, Thailand.</p> Participants <p>Thirty participants: 10 patients with life-limiting illness, 10 family caregivers, and 10 healthcare providers.</p> Methods <p>Semi-structured interviews were conducted at a palliative care center between January and October 2025. Interviews were transcribed verbatim, translated using meaning-based equivalence, and analyzed inductively using reflexive thematic analysis.</p> Results <p>Four themes (10 subthemes) conceptualized ACP as a relationally negotiated, culturally embedded practice. (1) Timing and pathways: emotional, familial, and structural readiness shaped when ACP became possible, most often during clinical crises. (2) Values and visions of a good death: comfort, peace, and minimizing burden guided preferences, while caregiving and resource constraints limited feasibility. (3) Communication as relational positioning in ACP: gentle honesty and paced disclosure fostered engagement; decisions were negotiated within family circles; physicians typically initiated ACP, while nurses sustained relational continuity. (4) Structural conditions shaping the possibility of ACP: hierarchy, workload, limited training, and constrained community support restricted proactive implementation, reinforcing reactive patterns.</p> Conclusion <p>ACP in this context functions as a relationally negotiated practice contingent upon alignment across emotional, familial, and structural readiness. Crisis initiation reflects misalignment across these domains rather than cultural resistance alone. Strengthening culturally attuned communication, family-centered engagement, interdisciplinary role clarity, and structural support may enable earlier and sustained ACP dialogue.</p>

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Patient, family, and healthcare provider experiences in advance care planning: a qualitative study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月14日

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  • Apiradee Pimsen,
  • Nedruetai Punaglom,
  • Anuwat Taweesuwanakrai,
  • Wanida Winyoohatthakit,
  • Siriluk Winitchayothin,
  • Supinda Ruangjiratain,
  • Virapun Wirojratana,
  • Ahmad Rifai

摘要

Background

Advance care planning (ACP) aligns care with patients’ values and improves end-of-life outcomes. Yet uptake remains limited and frequently crisis-triggered, particularly in collectivist contexts where family interdependence and emotional tolerance shape participation. Empirical understanding of how ACP is experienced across patients, families, and healthcare providers in non-Western settings remains limited.

Objective

To explore how patients, family caregivers, and healthcare providers experience and negotiate participation in ACP within a Thai palliative care context.

Design

Qualitative study using reflexive thematic analysis.

Setting

A university hospital in Bangkok, Thailand.

Participants

Thirty participants: 10 patients with life-limiting illness, 10 family caregivers, and 10 healthcare providers.

Methods

Semi-structured interviews were conducted at a palliative care center between January and October 2025. Interviews were transcribed verbatim, translated using meaning-based equivalence, and analyzed inductively using reflexive thematic analysis.

Results

Four themes (10 subthemes) conceptualized ACP as a relationally negotiated, culturally embedded practice. (1) Timing and pathways: emotional, familial, and structural readiness shaped when ACP became possible, most often during clinical crises. (2) Values and visions of a good death: comfort, peace, and minimizing burden guided preferences, while caregiving and resource constraints limited feasibility. (3) Communication as relational positioning in ACP: gentle honesty and paced disclosure fostered engagement; decisions were negotiated within family circles; physicians typically initiated ACP, while nurses sustained relational continuity. (4) Structural conditions shaping the possibility of ACP: hierarchy, workload, limited training, and constrained community support restricted proactive implementation, reinforcing reactive patterns.

Conclusion

ACP in this context functions as a relationally negotiated practice contingent upon alignment across emotional, familial, and structural readiness. Crisis initiation reflects misalignment across these domains rather than cultural resistance alone. Strengthening culturally attuned communication, family-centered engagement, interdisciplinary role clarity, and structural support may enable earlier and sustained ACP dialogue.