Thematic Analysis of Barriers to Completion of a Healthcare Proxy at a Comprehensive Cancer Center.

Advance care planning is an important component of comprehensive oncology care. Advance directives serve to extend patient autonomy and empower patients to have their preferences and values honored when they cannot speak for themselves. This is a critical component when patients are facing cancer treatment that may challenge their ability to fully participate in their care. A review of institutional practices and procedures identified an opportunity to improve the process for obtaining healthcare proxy documentation, a critical but approachable component of advance care planning. A multi-level assessment was performed utilizing focus groups consisting of patients and community members, medical professionals, and hospital administrators. Areas of concern, misconceptions, and process weaknesses were identified by qualitative thematic analysis. This analysis was utilized to identify institution-specific barriers to completion of a health care proxy. They can then be tailored to develop staff specific education to overcome these barriers, in cooperation with ongoing patient education efforts. The analysis also identified process and workflow barriers to completion, implementation, and access; the result is the identification of multiple opportunities for quality improvement within the cancer care setting. Ultimately, multi-level intervention to improve knowledge and comfort with health care proxies and advance care planning will enhance patient care.