ArticlePalliative medicine2021
The importance of living well now and relationships: A qualitative study of the barriers and enablers to engaging frail elders with advance care planning.
Article in Palliative medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 3 syntheses or guidelines pooled it, 52 citations in OpenAlex.
- Real experiences and care needs of frail older patients: a systematic review of qualitative studies.Frontiers in public health · 2025Pooled it
- Advance care planning for frail elderly: are we missing a golden opportunity? A mixed-method systematic review and meta-analysis.BMJ open · 2023Pooled it
- Development of a theory-based intervention to increase cognitively able frail elders' engagement with advance care planning using the behaviour change wheel.BMC health services research · 2021Pooled it
- Giving room for the existential response to serious illness: experiences with advance care planning among home-dwelling older persons admitted to acute geriatric care.European geriatric medicine · 2026Trial
- Raising awareness and preparation for what may come: next of kin experiences of advance care planning with frail, home-dwelling older adults in geriatric units.BMC health services research · 2025Trial
- Community-embedded follow-up management intervention for geriatric primary care: a mixed-methods study of an integrated health services model.BMC health services research · 2024Trial
- Complex advance care planning intervention in general practice (ACP-GP): a cluster-randomised controlled trial.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Trial
- Advance care planning engagement in patients with chronic, life-limiting illness: baseline findings from a cluster-randomised controlled trial in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Trial
- Experiences of Older Adults with Frailty Not Completing an Advance Directive: A Qualitative Study of ACP Conversations.International journal of environmental research and public health · 2022Trial
- Qualitative Analysis of Community Dwelling Older Adults' Advance Care Planning Interviews: Patients Want a Chance.The American journal of hospice & palliative care · 2026Article
- New horizons in advance care planning: narratives, identity and cultural humility.Age and ageing · 2026Review
- What are the barriers and facilitators to advance care planning with older people in long-term care facilities? A qualitative study.Journal of clinical nursing · 2026Article
- Intergenerational communication about advance care planning between older adults and their adult children: a qualitative dyadic study.BMC geriatrics · 2026Article
- Attitudes to earlier advance care planning: a qualitative interview study in general practice.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- What Do Older Adults with Frailty and Their Caregivers Want from Advance Care Planning Discussions? A Descriptive Qualitative Study.Healthcare (Basel, Switzerland) · 2025Article
- [What really matters can't be planned ahead : Impediments for advance care planning from a qualitative study on very old people living alone].Zeitschrift fur Gerontologie und Geriatrie · 2025Article
- Exploring older people's end-of-life care preferences over time: A scoping review.Palliative medicine · 2025Article
- Proactive end-of-life conversations in residential care homes: a qualitative interview study exploring residents' and family members' experiences.BMC geriatrics · 2025Article
- Frailty as a Predictor of Post-Traumatic Stress Disorder After Advance Care Planning Communication Intervention by Trained Care Managers in Long-Term Care Service Users in Japan: A Secondary Analysis.Journal of personalized medicine · 2025Article
- Exploring readiness for advance care planning in Japan: A qualitative interview study with older adults with frailty, family caregivers, and health and social care practitioners in the homecare setting.Palliative care and social practice · 2025Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundThe population of frail elders is growing, and due to their vulnerability to sudden deterioration, advance care planning is particularly important. However, advance care planning is uncommon for multiple reasons, some of which are linked to the perceptions of frail elders and their families.
aimTo explore the barriers and enablers to advance care planning engagement with frail elders.
designQualitative in-depth interviews with thematic analysis. SETTING/
participantsPurposive sample of 10 frail elders and 8 nominated family members using a community-based older persons' service run by a large urban UK hospice. Frail elders had capacity, were ⩾65 (median 85, range 71-95), scored 6 or 7 (median 6.5) on the Clinical Frailty Scale, and 70% were female.
resultsKey barriers were:
conclusionsEssential enablers for frail elders are understanding what advance care planning is and why it may be relevant to them. For professionals, enablers include recognising the importance of living well now and relational decision-making. To further support advance care planning, recommendations include early engagement and re-conceptualising advance care planning as an ongoing process which encompasses current and future care. Further research is needed in different cultures and care contexts.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.