67 The role of tacit knowledge in advance care planning: aged care staff perspectives

<h3>Research Background and Objectives</h3> Effective Advance Care Planning (ACP) in aged care relies on both explicit knowledge—such as clinical guidelines—and tacit knowledge, including professional judgment, interpersonal skills, and cultural sensitivity. Yet many staff lack the confidence and capability to facilitate ACP effectively. This study explores how aged care staff draw on both knowledge types to navigate systemic challenges and adapt to individual needs in person-centred ACP. <h3>Methods</h3> As part of a broader project examining how technologies like AI chatbots might enhance ACP, this study involved in-depth, semi-structured interviews with 25 Australian aged care staff across diverse roles and settings. Interviews were guided by a tacit knowledge framework, incorporating causal mapping and narrative techniques to elicit deeply held knowledge and emotional responses. <h3>Results</h3> Participants described ACP as a dynamic, iterative process requiring clinical knowledge and intuitive judgment to adapt to evolving patient needs, cultural contexts, and family dynamics. Staff emphasised the importance of gauging health literacy and willingness to engage in existential conversations, often using humour, reframing, or personal anecdotes to foster openness and build trust. They recognised that patient preferences shift over time, requiring regular review. However, challenges arose in setting realistic expectations within system constraints. Participants expressed frustration with compliance-driven models, raising concerns that organisational pressures sometimes lead to coercive practices and undermine individual autonomy. Unsupportive organisational cultures and poor system integration further eroded trust in ACP as a meaningful component of care. <h3>Discussion</h3> The findings highlight that tacit knowledge—expressed through professional judgment, interpersonal skills, emotional intelligence, and cultural sensitivity—is critical for building rapport and trust during ACP. These skills enable staff to navigate complex family dynamics, cultural norms, and changing patient preferences. However, they are insufficient without organisational support, including training, reflective practice, and system-level changes to address time pressures, competing demands, and unsupportive environments. <h3>Unique Contribution</h3> This study offers new insights into ACP implementation by showing how tacit knowledge, including professional judgment and cultural sensitivity, supports more meaningful, person-centred conversations in aged care. <h3>Implications</h3> Insights from this study will inform the design of an AI chatbot trained with both explicit guidelines and tacit knowledge from staff experiences. This tool will be evaluated for its potential to enhance staff confidence and capability in conducting ACP conversations within aged care.