Conversations Worth Having: The Perceived Relevance of Advance Care Planning among Teachers, Hospice Staff, and Pastors in Knysna, South Africa

Abstract Background: Little is known about the relevance of advance care planning (ACP), including the use of advance directives (AD) and health care power of attorney in transitional countries where access to health care is often limited. Objective: The study's objective was to determine the perceived relevance of ACP amongst select groups in the South African community, and to refine an existing tool for initiating conversations on the topic. Design: Five focus groups were recruited, with a total of 51 participants, including pastors, hospice staff, teachers, and community caregivers. Methods: The concept of ACP was introduced. Participants reflected on its relevance, how best to approach the topic, and what aspects ACP should cover. Participants also evaluated an existing tool for initiating conversations about ACP, with their respective communities in mind. Results: There was broad recognition of the unexplored benefit of ACP, as well as barriers to initiating conversations. Respondents agreed that AC...