Table 2.

Challenges and barriers to ACP

Challenges	Barriers
Identifying the best time and most appropriate person to introduce ACP issues to patients	Lack of resources (including time and end-of-life services) with which to meet patients' preferences and support family carers
Managing differences in staff understandings of ACP in the wider health care team	Lack of public and patients' awareness about ACP and other end-of-life issues
Managing the emphasis on instructional directives and the drive to bureaucratize ACP practice	Taboos and fears about death and dying among public and patients
Documentation and communication of ACP discussions across health care systems
Managing the potential conflict or difference between patient and family carers' views