Patient, family, and healthcare provider experiences in advance care planning: a qualitative study

Advance care planning (ACP) aligns care with patients’ values and improves end-of-life outcomes. Yet uptake remains limited and frequently crisis-triggered, particularly in collectivist contexts where family interdependence and emotional tolerance shape participation. Empirical understanding of how ACP is experienced across patients, families, and healthcare providers in non-Western settings remains limited. To explore how patients, family caregivers, and healthcare providers experience and negotiate participation in ACP within a Thai palliative care context. Qualitative study using reflexive thematic analysis. A university hospital in Bangkok, Thailand. Thirty participants: 10 patients with life-limiting illness, 10 family caregivers, and 10 healthcare providers. Semi-structured interviews were conducted at a palliative care center between January and October 2025. Interviews were transcribed verbatim, translated using meaning-based equivalence, and analyzed inductively using reflexive thematic analysis. Four themes (10 subthemes) conceptualized ACP as a relationally negotiated, culturally embedded practice. (1) Timing and pathways: emotional, familial, and structural readiness shaped when ACP became possible, most often during clinical crises. (2) Values and visions of a good death: comfort, peace, and minimizing burden guided preferences, while caregiving and resource constraints limited feasibility. (3) Communication as relational positioning in ACP: gentle honesty and paced disclosure fostered engagement; decisions were negotiated within family circles; physicians typically initiated ACP, while nurses sustained relational continuity. (4) Structural conditions shaping the possibility of ACP: hierarchy, workload, limited training, and constrained community support restricted proactive implementation, reinforcing reactive patterns. ACP in this context functions as a relationally negotiated practice contingent upon alignment across emotional, familial, and structural readiness. Crisis initiation reflects misalignment across these domains rather than cultural resistance alone. Strengthening culturally attuned communication, family-centered engagement, interdisciplinary role clarity, and structural support may enable earlier and sustained ACP dialogue. In collectivist healthcare systems, ACP depends on alignment across emotional, familial, and structural readiness. Without coordinated relational and institutional support, conversations remain crisis-triggered despite shared endorsement of dignified, non-burdensome care.