Barrier	Contributing factors	Example responses
Not knowing VAD exists as a legal option	Registered health practitioners legally prohibited from raising VAD as an option. Limited health literacy, especially for some diverse populations such as those from CALD backgrounds. Limited Internet proficiency, especially for older people.	Repeal legal prohibition on raising VAD. Community awareness initiatives about VAD as a legal option (including specific strategies to promote community awareness in CALD populations developed in consultation with organisations that support them). Enhanced Internet resources both in terms of their clarity and being able to find the resources on the web (including search engine optimisation). Enhanced print resources, and more widely available e.g. in hospitals and general practice clinics.
Not recognising a person is potentially eligible for VAD	Registered health practitioners legally prohibited from raising VAD as an option. Not knowing that VAD is available for a range of qualifying illnesses, other than just cancer. Not knowing a person's prognosis (eligibility criteria requires anticipated death within 6 months or 12 months for neurodegenerative conditions).	Repeal legal prohibition on raising VAD. Community awareness initiatives about VAD, which include information about who may access VAD. Resources should not only include cancer but other diseases as well and disease‐specific organisations should be engaged in these initiatives. When a patient may be eligible for VAD, the treating doctor should give consideration to sensitively discussing likely prognosis and treatment options so a patient can be aware that they may be eligible for VAD. (This discussion is currently made more difficult because of the legal prohibition on raising VAD but should include sensitively raising the option of VAD if appropriate and the legal prohibition is repealed).
Not knowing the next steps or not being able to achieve them in practice	Not being able to find information about the next steps needed to connect with the VAD system.	Enhanced Internet resources both in terms of their clarity and being able to find the resources on the web (including search engine optimisation). Also enhanced print resources. These resources should include clear guidance on steps needed and easily locatable relevant contact details to progress a request for VAD.
	Not being able to identify a trained and willing doctor to assess VAD eligibility.	Require nonparticipating doctors to refer patients to a willing doctor, or alternatively provide contact details of the VAD Care Navigators to ensure connection with the VAD system. Increase the pool of trained and willing doctors, particularly in general practice given it is likely to be the first point of contact. This could be done in a range of ways including: making the criteria for doctors to participate in VAD less onerous (to our knowledge, Victoria has the most onerous requirements internationally); and providing adequate time and/or remuneration for doctors to be involved in VAD and for them to undertake the mandatory training.
	Not knowing about the VAD Care Navigators (or local health service coordinator) or being able to find them.	Enhanced Internet resources both in terms of their clarity and being able to find the resources on the web (including search engine optimisation). Also enhanced print resources. These resources should include clear guidance on steps needed and easily locatable relevant contact details for VAD Care Navigators. Require nonparticipating doctors to refer patients to a willing doctor, or alternatively provide contact details of the VAD Care Navigators to ensure connection with the VAD system.
	Institutional objection.	Require objecting healthcare institutions to at least provide information about VAD if patients ask about it, including the contact details of the VAD Care Navigators (other steps may also be required to address other access issues but provision of information should be sufficient to address point of access issues).
Challenges with patients being required to raise the topic of VAD first	Not knowing that registered health practitioners are legally prohibited from raising VAD as an option.	Repeal legal prohibition on raising VAD. Community awareness initiatives about VAD, which include information that it must be the patient who raises the issue of VAD.
	Raising VAD with a doctor is difficult.	Repeal legal prohibition on raising VAD. Conversation guides to support patients wishing to raise VAD, easily locatable on the web. Further training for doctors about VAD, so they can recognise when a patient may be requesting VAD, and if the legal prohibition is repealed, so they are comfortable raising VAD if appropriate. There should also be training about end‐of‐life conversations generally to make such discussions easier for patients.
	Not knowing the words sufficient to have raised the topic of VAD so it may be discussed with a doctor.	Repeal legal prohibition on raising VAD. Conversation guides to support patients wishing to raise VAD, easily locatable on the web. Further training for doctors about VAD so they can recognise when a patient may be requesting VAD, and if the legal prohibition is repealed, so they are comfortable raising VAD if appropriate.
	Stigmatisation of VAD because, unlike other healthcare, it cannot be openly raised with patients.	Repeal legal prohibition on raising VAD. Community awareness initiatives about VAD, which include addressing potential stigmatisation of VAD.

Abbreviations: CALD, culturally and linguistically diverse; VAD, voluntary assisted dying.

^a These responses are proposed with acknowledgment that in Victoria (the site of this research), there is already some existing work undertaken to address the issues identified. See for example the consumer‐facing website: Department of Health, Victoria State Government. Community and consumer information. Accessed July 14, 2023. https://www.health.vic.gov.au/patient-care/community-and-consumer-information