Table 6.

Barriers and Facilitators Identified by Clinicians During Qualitative Interviews

Qualitative Themes for Clinicians
Subtheme	Common barriers to implementation for both forms
Time	Almost all clinicians in both study arms reference the extra time required, ranging from 30 seconds to 20 minutes, averaging approximately 3 to 5 minutes extra. Several didn’t mind finding the time because they felt it was important. Reimbursement codes help.
Barriers and facilitators identified	Forgetting to offer forms, misunderstandings about how to address existing/multiple forms, pts forgetting to complete forms, pts forgetting to return forms, new EHR implementation, location and managing forms in EMR. Facilitators: involvement of nursing staff as part of the introduction, important to be part of the check-in flow/routine, offer to everyone, script cards for nursing staff. Lack of sustainable reminders in place; numerous competing priorities; time pressures; EHR system change; Facilitators: systematic planning; effective teamwork; securing buy-in from entire clinic prior to implementation; professional experience with EOL conversations; “Bringing the attention.”

EHR, electronic health record; EOL, end-of-life.