Help patients prepare for the last phase of life.

Help patients to be more conscious about the choices they might have.

Contribute to the feeling of control in a difficult and new situation.

Contribute to clarification of treatment intensity.

Create a basis for communication about ethically challenging decisions.---------------------

Clinicians found new, valuable information about the patients in the summaries, which they sometimes chose to pass on to the primary healthcare services.

Some clinicians highlighted that many of the patients at the department of thoracic medicine are diagnosed with incurable disease, which makes an early focus on ACP and mapping of palliative care needs important.

It was not clear who should be responsible for ACP conversations; physicians wanted to have this communication with their patients, but nurses more often asked for it.

Introducing an unknown person (the study nurse) for ACP conversations near the end of life was debatable. The participants called for education, training and allocated time to be able to have these conversations themselves.

Some questioned whether ACP was a task for clinicians in hospitals or community services, and pointed at the key position of the general practitioner.

The fact that hospitals and community services have different electronic patient record systems that do not communicate with each other was mentioned as a problem. The new, electronic national Summary Care Record was regarded as the optimal place for both ICP and ACP documentations.

The participants called for an overarching policy and plan for ACP at the hospital, as a means to integrate ACP conversations as an obvious part of the discharge planning, optimally as part of an ICP that assigns tasks and responsibilities.

Clinicians acted as gatekeepers during the process of recruitment.

Clinicians were concerned about the purpose of ACP, whether it was solely for the patient or if the intention also was to equip relatives and staff with important information.

There was a dissent whether only a minority of the patients needed ACP conversations or if these conversations were relevant for many patients at an early stage of their disease.

It was difficult to find time for structured conversations during short admissions.

Clinicians found it hard to find time for ACP conversations in their busy daily schedule.

Clinicians felt they knew the patients and called for time to carry out ACP conversations themselves.

Clinicians were afraid of violating patients and depriving them of hope.

They preferred to defuse the subject of ACP by introducing it during the physician’s round.

They questioned if a hospital stay was the optimal timing for an ACP conversation, compared with the outpatient clinic in a more stable phase of the disease.