Implementing a digital advance care plan in practice: a qualitative study of healthcare professionals’ perspectives

OBJECTIVES: This study examines healthcare professionals' (HCPs') experiences of implementing digital advance care plans (DACPs) to support information-sharing and decision-making in end-of-life care (EoLC) across an Integrated Care Board in Southwest England. It provides evidence of HCPs' perspectives towards the potential of DACPs to enhance the coordination of patient care. METHODS: A descriptive qualitative study was conducted. Purposive sampling recruited HCPs from diverse clinical settings. Four focus groups and one semi-structured interview were conducted between November 2024 and November 2025. Data were analysed inductively using thematic analysis. Reflexive practice was embedded throughout, acknowledging the research team's clinical and qualitative experience and potential influence on interpretation. RESULTS: 15 HCPs participated. Three overarching themes were identified: (1) Variations in DACP use-some clinicians acting as creators and others as viewers, shaping perceptions of value and workload. (2) Perceived benefits-improved information-sharing, enhanced decision-making in crises and support for nuanced and patient-centred planning. (3) Challenges-fragmented clinical systems, inconsistent updating, variable understanding of DACP purpose and tensions between detailed content and the need for rapid, actionable information. Participants highlighted that DACPs could guide multidisciplinary team (MDT) discussions and contingency planning but were limited by system integration issues and inconsistent use across settings. CONCLUSIONS: DACPs have considerable potential to enhance EoLC by improving communication, supporting personalised decision-making and supporting crisis response. Realising these benefits requires improved system interoperability, clearer role expectations and consistent updating across settings. Strengthening digital infrastructure and embedding DACPs into routine MDT processes may help them function as dynamic, evolving records supporting high-quality EoLC.