Themes, subthemes and illustrative quotes.

<div><p>Background</p><p>Care planning with people with advanced heart failure enables appropriate care, and prevents futile interventions, such as cardio-pulmonary resuscitation (CPR).</p><p>Aim</p><p>To explore what motivates clinicians to conduct, and people with heart failure and their carers, to engage in well-conducted CPR discussions.</p><p>Methods</p><p>In-depth remote interviews with i) people with heart failure and self-reported daily symptoms (≥ 3 months), ii) informal carers and, iii) clinicians recruited through social media and professional groups, team contacts and snowballing. Interviews were audio-recorded, transcribed, anonymised and subjected to framework analysis. Findings were mapped to the Capabilities, Opportunities, Motivation-Behaviour change model.</p><p>Results</p><p>Two themes were generated from 23 interviews: a) the cardio-pulmonary resuscitation discussion: preparation; who should conduct discussions; what should happen during discussions; impact on future discussions; b) Understanding of the: patient’s health status; and purpose and likely outcome of cardio-pulmonary resuscitation. For clinicians, ensuring preparation time, education, and support provided <i>physical and psychological capability</i>. For all, constructive experiences and a realistic understanding of health status and likely cardio-pulmonary resuscitation outcome <i>motivated</i> engagement in cardio-pulmonary resuscitation discussions providing <i>opportunity</i> for patient involvement in decision-making.</p><p>Conclusions</p><p>For all, constructive past experiences of important conversations <i>motivates</i> engagement with CPR discussions. A realistic understanding of health status and likely cardio-pulmonary resuscitation outcome (all stakeholders), and training, skills, preparation and multidisciplinary support (clinicians) provide <i>physical and psychological capability</i>. Findings should inform organisational structures and training to ensure <i>opportunity</i> for this important clinical practice to take place.</p></div>