“…Lily (R-DAS 59) -I still feel like a lot of [whether I avoid the conversation] comes down to whether the doctors have discussed it fully with the patient ... especially when you're planning the patients end-of-life, they want to hear it from the doctor. They don't want to hear it from [an occupational therapist] Diane, a nurse, described delaying discussing advance care as long as possible, based on a doctor's assessment of the patients' prognosis:Diane (R-DAS 52) -we don't tend to discuss their wishes with them until the doctor has actually said this person doesn't have long left … before that you're thinking well obviously we hope this won't be needed as they will be able to go home Diane's apparently reactive approach could sacrifice the potential benefits of earlier advance care planning, which enables more time for discussion, multi-disciplinary team involvement, or referral to palliative care(Eskins et al, 2017). Diane's approach may reflect lack of training, for only one participant (Amanda) reported receiving any training in completing an Advance Decision to Refuse Treatment (ADRT), and only one of the doctors (Joseph) reported ever seeing ADRT documentation.…”