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End-Stage Renal Disease (ESRD) patients experience high rates of cognitive impairment and lower quality of life at end of life. Having an advance care planning (ACP) conversation is associated with better care at end of life and improved care consistency with patient preferences. Taiwan ranks highest in ESRD and dialysis incidence worldwide, highlighting the importance of ACP among this population. Since 2019, the Patient Autonomy Act entitled Taiwanese to engage in ACP, but strategies to promote its uptake and the role of healthcare providers and caregivers in ACP conversations remains unclear. This study aimed to investigate facilitators and barriers to ACP engagment among Taiwanese with kidney disease and their caregivers. In 2020, we recruited 18 adults with stage 3—5 kidney disease and their caregivers. We conducted semi-structured interviews to elicit knowledges and perspectives on ACP. A grounded theory approach was used to guide the analysis of primary themes. Two researchers independently coded the transcripts and met to reconcile codes. The primary barrier to ACP was the misconception that it equated to funeral arrangements. Themes related to ACP facilitators included: trust in the nephrology care team (especially in case managers); straighforward communication; and in-person consultations. Additionally, transplant patients were more likely to have ACP discussions with their loved ones. While kidney disease patients preferred straightforward communication, caregivers preferred indirect communications. These findings emphasize the critical role of the nephrological care team members. Improving knowledge of ACP and facilitating communication between caregivers and kidney disease patients in Taiwan is needed.

Facilators and Barriers to Advance Care Planning Engagement among Chronic Kidney Patients in Taiwan