{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T09:13:11Z","timestamp":1783588391354,"version":"3.55.0"},"reference-count":48,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100013121","name":"Sydney West Translational Cancer Research Centre","doi-asserted-by":"publisher","award":["15\/TRC\/1-01"],"award-info":[{"award-number":["15\/TRC\/1-01"]}],"id":[{"id":"10.13039\/100013121","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cancer Control"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Advance Care Planning (ACP) is a patient-centered process that enables individuals to consider their goals and priorities and make plans with their healthcare team for future care. Oncology clinicians care for critically ill patients and are central to facilitating and documenting ACP. While Australian and international guidelines strongly support ACP in oncology, clinician engagement and documentation of ACP remain suboptimal. This study aimed to explore oncology clinicians\u2019 ACP knowledge, decision-making, and practice, including factors influencing engagement in ACP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative study was conducted using semi-structured interviews with oncology clinicians from three metropolitan hospitals in New South Wales, Australia. Participants were purposefully sampled and interviewed between November 2021 and March 2022. Interviews were audio-recorded, transcribed, and analyzed using deductive thematic analysis guided by the Theoretical Domains Framework (TDF). An inductive approach was subsequently applied to develop explanatory subthemes within identified domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eleven clinicians participated, including Medical\/Radiation Oncology Consultants (54.5%) and Advanced Trainees (45.5%). Interview length ranged from 17.5 to 35.5 minutes. A total of 380 quotes were coded across all 14 TDF domains, generating 33 explanatory subthemes. Four domains were most influential: Knowledge and Skills, Social\/Professional Role and Identity, Environmental Context and Resources, and Social Influences. Although all participants recognized ACP as best-practice care, engagement was influenced by limited formal training and legal literacy, uncertainty regarding responsibility for initiating and documenting ACP, variable inconsistent interdisciplinary communication, workload and time constraints, electronic medical record functionality, and patient characteristics (i.e.,psychological state, health literacy, cultural complexity).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ACP in oncology is shaped by complex, interdependent socio-cultural and organizational factors. Applying the TDF identified key behavioral and contextual determinants. Improving ACP requires multilevel strategies targeting clinician capability, role clarity, and system-level supports, including structured education, clearer documentation processes, improved electronic medical record functionality, and integration of ACP into routine multidisciplinary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10732748261441920","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T09:55:43Z","timestamp":1783418143000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Influencing Advance Care Planning in Oncology: A Qualitative Study of Clinician Perspectives Using the Theoretical Domains Framework"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4398-2908","authenticated-orcid":false,"given":"Candice","family":"Donnelly","sequence":"first","affiliation":[{"name":"The University of Sydney"},{"name":"The Daffodil Centre, The University of Sydney and Cancer Council NSW, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7770-8790","authenticated-orcid":false,"given":"Kavisha","family":"Shah","sequence":"additional","affiliation":[{"name":"The University of Sydney"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3802-377X","authenticated-orcid":false,"given":"Sally","family":"Greenaway","sequence":"additional","affiliation":[{"name":"Western Sydney Local Health District"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Harnett","sequence":"additional","affiliation":[{"name":"Western Sydney Local Health District"},{"name":"Western Sydney Local Health District"},{"name":"Western Sydney & Nepean Blue Mountains Local Health Districts,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0783-1918","authenticated-orcid":false,"given":"Tim","family":"Shaw","sequence":"additional","affiliation":[{"name":"The University of Sydney"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6611-9651","authenticated-orcid":false,"given":"Anna","family":"Janssen","sequence":"additional","affiliation":[{"name":"The University of Sydney"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2016.12.331"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30582-X"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2020.0774"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-022-01099-9"},{"key":"e_1_3_8_6_2","volume-title":"Using Resuscitation Plans in End of Life Decisions [PD2014_030]","author":"NSW Government","year":"2014","unstructured":"NSW Government. Using Resuscitation Plans in End of Life Decisions [PD2014_030]. Sydney, NSW: Agency for Clinical Innovation; 2014."},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216314526272"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-082766"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.05.016"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16801"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-012387"},{"key":"e_1_3_8_12_2","volume-title":"National Consensus Statement: Essential elements for safe and high-quality end-of-life care","author":"Australian Commission on Safety and Quality in Health Care","year":"2023","unstructured":"Australian Commission on Safety and Quality in Health Care. National Consensus Statement: Essential elements for safe and high-quality end-of-life care. Sydney, NSW: ACSQHC; 2023."},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1200\/jop.2017.021246"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2015.1976"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1071\/AH15120"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.70.1474"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2021.0033"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdu241"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05878-z"},{"key":"e_1_3_8_20_2","volume-title":"Prevalence of advance care planning documentation in Australian health and residential aged care services: report 2019","author":"Buck K","year":"2019","unstructured":"Buck K, Detering K, Sellars M, et al. Prevalence of advance care planning documentation in Australian health and residential aged care services: report 2019. Melbourne, VIC: Advance Care Planning Australia, Austin Health. 2019."},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.1200\/jop.18.00044"},{"key":"e_1_3_8_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2024.101737"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/onco.13640"},{"key":"e_1_3_8_24_2","volume-title":"Specialist palliative care use for older people receiving aged care","author":"Australian Institute of Health and Welfare","year":"2025","unstructured":"Australian Institute of Health and Welfare. Specialist palliative care use for older people receiving aged care. Canberra, ACT: AIHW, Australian Government; 2025. Accessed 26 February 2026."},{"key":"e_1_3_8_25_2","volume-title":"Classifying place of death in Australian mortality statistics","author":"Christison M","year":"2021","unstructured":"Christison M, Webster S, Eynstone-Hinkins J. Classifying place of death in Australian mortality statistics. Canberra, ACT: Australian Bureau of Statistics; 2021."},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-019-0448-z"},{"key":"e_1_3_8_27_2","doi-asserted-by":"publisher","DOI":"10.1071\/ah20223"},{"key":"e_1_3_8_28_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-020-00655-5"},{"key":"e_1_3_8_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3926"},{"key":"e_1_3_8_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13187-017-1225-4"},{"key":"e_1_3_8_31_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2019.0402"},{"key":"e_1_3_8_32_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0605-9"},{"key":"e_1_3_8_33_2","doi-asserted-by":"publisher","DOI":"10.1348\/135910708X397025"},{"key":"e_1_3_8_34_2","doi-asserted-by":"publisher","DOI":"10.1186\/s42466-020-00059-z"},{"key":"e_1_3_8_35_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_3_8_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-013-0528-y"},{"key":"e_1_3_8_37_2","unstructured":"Royal Australasian College of Physicians (RACP). Advance Training Medical Oncology. https:\/\/www.racp.edu.au\/trainees\/advanced-training\/medical-oncology. Accessed 1 Oct 2025."},{"key":"e_1_3_8_38_2","unstructured":"The Royal Australian and New Zealand College of Radiologists (RANZCOG). Radiation Oncology Training Program. https:\/\/www.ranzcr.com\/trainees\/radiation-oncology-training-program\/training-program. Accessed 1 Oct 2025."},{"key":"e_1_3_8_39_2","doi-asserted-by":"publisher","DOI":"10.1080\/08870440903194015"},{"issue":"6","key":"e_1_3_8_40_2","first-page":"2061","article-title":"Using framework analysis in applied qualitative research","volume":"26","author":"Goldsmith LJ","year":"2021","unstructured":"Goldsmith LJ. Using framework analysis in applied qualitative research. Qualitative report. 2021;26(6):2061-2076.","journal-title":"Qualitative report"},{"key":"e_1_3_8_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/imj.13389"},{"key":"e_1_3_8_42_2","doi-asserted-by":"publisher","DOI":"10.6004\/jadpro.2021.12.1.7"},{"key":"e_1_3_8_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.nurpra.2017.11.023"},{"key":"e_1_3_8_44_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003422"},{"key":"e_1_3_8_45_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-022-00672-8"},{"key":"e_1_3_8_46_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4192-0"},{"key":"e_1_3_8_47_2","volume-title":"Review of advance care planning laws across Australia: short report","author":"Fountain S","year":"2018","unstructured":"Fountain S, Nolte L, Wills M, Kelly H, Detering K. Review of advance care planning laws across Australia: short report. Melbourne, VIC: Advance Care Planning Australia, Austin Health; 2018."},{"key":"e_1_3_8_48_2","unstructured":"Australian Government Department of Health. National Palliative Care Strategy. 2018. https:\/\/www.health.gov.au\/sites\/default\/files\/the-national-palliative-care-strategy-2018-national-palliative-care-strategy-2018.pdf"},{"key":"e_1_3_8_49_2","volume-title":"Policy Directive Using Resuscitation Plans in End of Life Decisions [PD2014_030]","year":"2014","unstructured":"Policy Directive Using Resuscitation Plans in End of Life Decisions [PD2014_030]. Sydney, NSW: Agency for Clinical Innovation; 2014."}],"container-title":["Cancer Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10732748261441920","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10732748261441920","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10732748261441920","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T08:17:31Z","timestamp":1783585051000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10732748261441920"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":48,"alternative-id":["10.1177\/10732748261441920"],"URL":"https:\/\/doi.org\/10.1177\/10732748261441920","relation":{"has-review":[{"id-type":"doi","id":"10.1177\/10732748261441920\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748261441920\/v2\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748261441920\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748261441920\/v2\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748261441920\/v1\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748261441920\/v1\/review2","asserted-by":"object"}]},"ISSN":["1073-2748","1526-2359"],"issn-type":[{"value":"1073-2748","type":"print"},{"value":"1526-2359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"article-number":"10732748261441920"}}