69 Bridging gaps in advance care planning: implementing sustainable practice change through provider and consumer alignment

<h3>Aim</h3> To explore misalignments between healthcare provider and consumer perspectives on advance care planning (ACP) and identify opportunities to improve its uptake and integration into routine oncology care. <h3>Background</h3> Despite strong evidence supporting ACP, engagement remains low in oncology settings. ACP ensures that patient preferences for future care are understood and documented, yet discussions are often delayed or overlooked. Current models tend to be provider-driven, failing to align with consumer expectations regarding when, where, and how ACP should occur. <h3>Main Narrative</h3> This study explored how ACP is currently delivered versus how it should be delivered from consumer and provider perspectives. Focus groups conducted with healthcare professionals (n=13) and consumers (n=11) mapped ACP process, identifying preferences across phases in terms of who, should be doing what, where, when, and to whom. Consumers consistently preferred ACP discussions to take place earlier in their care journey and in non-clinical settings, while providers typically initiated conversations only at times of clinical deterioration. A critical gap was identified in the follow-up and integration of ACP documents, leaving many preferences unenacted at the point of care. Co-design workshops with key stakeholders (n=12) developed implementation strategies that targeted identified gaps and addressed barriers to better align practice with consumer preferences at critical ACP touchpoints. <h3>Unique Contribution</h3> This study highlights fundamental misalignments in ACP delivery, particularly regarding timing, setting, and accessibility. This work amplifies the consumer voice and presents a novel application of the AACTT framework to map preferences of both health professionals and consumers, identifying overlooked barriers that impact engagement and implementation. Strategies to address low uptake of ACP were not only designed to overcome practical barriers but also uniquely aimed to align ACP practice with consumer preferences—tackling a higher-order, or ‘meta’, barrier to engagement stemming from a mismatch between current practice and what consumers actually want. <h3>Implications for Policy and Practice</h3> Embedding ACP into routine care requires a shift from reactive to proactive engagement. ACP discussions should not be solely linked to disease progression but integrated into the patient journey from early stages. Clinician training must focus on initiating conversations earlier, while systemic improvements are needed to standardise documentation, ensuring ACP preferences are accessible and actionable at critical decision points. Aligning ACP practices with consumer expectations and clinical workflows will enhance engagement, reduce unwanted interventions, and improve the quality of end-of-life care.