Exploring influences on community-based case managers' advance care planning practices: facilitators or barriers?

Community-based geriatric case managers work with an increasingly frail older population in need of advance care planning throughout the end of life. However, little is known regarding factors that influence their professional practices in this area. This qualitative study used four focus groups to explore case managers' (N = 27) perceptions of facilitators and barriers to advance care planning practices. Themes from the study suggest that case managers view five key influences that appear to either assist or impede practices, depending on case manager's perceptions and experiences. Themes include: (1) Paradox of case management and programmatic realities; (2) extent of family presence and involvement; (3) level of proficiency in advance care planning; (4) degree of client receptivity to planning; and (5) limited communication with providers. The findings suggest that case managers vary in their advance care planning practices by differing perceptions regarding clients, families, professional expertise, program effects, and communication within the network of providers. More research is needed to clarify the factors associated with case managers' divergent advance care planning practices in order to enhance professional practice in this area.