Table 4

Key enablers mapped to socioecological levels of influence and frequency reported

Level identifiedEnablerNo of studiesReferences
Individual levelDemographic likelihood (increased age)3 41 66 67
Education and public awareness7 31 43 56 67–70
Stage of change—readiness6 15 34 39 43 47 71
Timing6 13 31 61 65 67 69
Interpersonal levelDoctor–patient relationship (strength, length of, trust, familiarity)10 14 15 42 48 49 61–64 67
Nurse–patient relationship5 14 64 72–74
Conversation and deliberation5 14 43 57 64 65
Group interaction2 66 73
Previous experience with ACP4 15 31 47 58
Provider levelGP and practice nurse education and communication training8 14 60 65 69 74–77
GP or practice nurse initiating the ACP discussion6 14 46 50 52 63 74
GP with philosophical agreement to ACP8 40 42 43 49 55 57 58 63
GP engagement in team approach3 60 64 66
System levelIT systems—portals, prompts, decision aids8 44 46 54 59 63 64 71 80
Templates6 57 63 67 70 75 78
Business as usual processes and protocols11 13 39 46 50 51 54 56 65 67 69 76
Models of care—group appointments, nurse led clinics, ACP facilitators10 14 49 60 64 66 72–74 76 79
  • ACP, advance care planning.