Table 3.

Reasons for Missed Conversations^a

Categories	Definition	Exemplar
Inquiry	Conversations where residents and family were asked or not asked about preferences related to end of life. Predominantly, “No one asked.”	Regarding staff inquiring about EOL preferences: “They never asked me.” (family) “No, I wasn't questioned at all.” (resident)
Assumptions	Ways residents, family, and staff believed resident preferences were already known (they know and presence of AD).	“They know: Just know her. I haven't asked her…. I know she didn't want them to suffer and she wouldn't want to suffer.” (family) “Presence of advance directive: I know what it means, they [staff] know what it means.” (family)
Conveying	How resident preferences related to end of life were conveyed (to others).	“No. No, that's just confidence. Because who would I pass it on to? I wouldn't tell her family and that's confidential.” (staff)

^aExchanges that did not occur or were not continued between residents, family, and/or staff related to EOL preferences of residents: who residents talked to, what they talked about, and when they talked about it.