Factors Influencing Advance Care Planning in Oncology: A Qualitative Study of Clinician Perspectives Using the Theoretical Domains Framework.

IntroductionAdvance Care Planning (ACP) is a patient-centered process that enables individuals to consider their goals and priorities and make plans with their healthcare team for future care. Oncology clinicians care for critically ill patients and are central to facilitating and documenting ACP. While Australian and international guidelines strongly support ACP in oncology, clinician engagement and documentation of ACP remain suboptimal. This study aimed to explore oncology clinicians' ACP knowledge, decision-making, and practice, including factors influencing engagement in ACP.MethodsA qualitative study was conducted using semi-structured interviews with oncology clinicians from three metropolitan hospitals in New South Wales, Australia. Participants were purposefully sampled and interviewed between November 2021 and March 2022. Interviews were audio-recorded, transcribed, and analyzed using deductive thematic analysis guided by the Theoretical Domains Framework (TDF). An inductive approach was subsequently applied to develop explanatory subthemes within identified domains.ResultsEleven clinicians participated, including Medical/Radiation Oncology Consultants (54.5%) and Advanced Trainees (45.5%). Interview length ranged from 17.5 to 35.5 minutes. A total of 380 quotes were coded across all 14 TDF domains, generating 33 explanatory subthemes. Four domains were most influential: Knowledge and Skills, Social/Professional Role and Identity, Environmental Context and Resources, and Social Influences. Although all participants recognized ACP as best-practice care, engagement was influenced by limited formal training and legal literacy, uncertainty regarding responsibility for initiating and documenting ACP, variable inconsistent interdisciplinary communication, workload and time constraints, electronic medical record functionality, and patient characteristics (i.e.,psychological state, health literacy, cultural complexity).ConclusionACP in oncology is shaped by complex, interdependent socio-cultural and organizational factors. Applying the TDF identified key behavioral and contextual determinants. Improving ACP requires multilevel strategies targeting clinician capability, role clarity, and system-level supports, including structured education, clearer documentation processes, improved electronic medical record functionality, and integration of ACP into routine multidisciplinary care.