Unveiling facilitators and barriers on advance care planning among community-dwelling older adults with chronic disease during the COVID-19 pandemic: A qualitative study on stakeholders' perspectives.

This study aimed to investigate the facilitators and barriers to participating in Advance Care Planning (ACP) among community-dwelling older adults with chronic diseases during the COVID-19 pandemic. A qualitative, face-to-face, in-depth interview was conducted using a semi-structured interview guide. This study interviewed 13 community-dwelling older adults with at least one chronic disease, 12 primary family caregivers, and 11 community nurses in the Beitou district communities of Taipei City, Taiwan. Facilitators included 1) The weaving of influence in communal ties, 2) Experience of illness and physical function decline, 3) Uncertainty and economic consideration of the healthcare process, and 4) Alertness to COVID-19. Barriers included 1) Complex procedures and requirements for participation, 2) Tradition-bound decision-making: culture norms influences on end-of-life planning, 3) Deferred decision-making: perceived distance from mortality, and 4) Effect of COVID-19 on routine care. Promoting ACP through community influencers, simplifying policy procedures, reducing service fees, and respecting Chinese cultural norms could encourage participation.