Table 2.
Clinician-Identified Barriers to Advance Care Planning Among Structurally Marginalized Patients
| Barrier | Number of Clinicians, N (%) |
|---|---|
| Patient-level barriers | 46 (62.2) |
| Reluctance to discuss ACP due to religious, cultural, or personal beliefs | 21 (28.4) |
| Distrust of clinicians or health systems | 19 (25.7) |
| Deference to family for decision making | 10 (13.5) |
| Low health literacy | 9 (12.2) |
| Lack of capacity to make medical decisions | 5 (6.8) |
| No available surrogates | 4 (5.4) |
| Clinician-level barriers | 26 (35.1) |
| Implicit bias | 12 (16.2) |
| Discomfort discussing ACP with structurally marginalized patients | 9 (12.2) |
| Limited time to discuss ACP due to medical complexity | 5 (6.8) |
| Health system-level barriers | 28 (37.8) |
| Insufficient language interpretation services | 23 (31.1) |
| Limited health system access due to underinsurance | 4 (5.4) |
| Insufficient workforce diversity | 1 (1.4) |
Note: ACP = advance care planning.