Objectives/Purpose
This study aimed to apply the AACTT framework (Action, Actor, Context, Target, Time) in a novel way to map healthcare provider and consumer perspectives across a complex intervention, advance care planning (ACP), to identify alignment and misalignment across behavioural domains.
Sample and Setting
Four focus groups (n=24) were conducted with healthcare professionals and consumers at Peter MacCallum Cancer Centre, a leading cancer hospital in Australia. Participants represented diverse disciplines and lived experiences of cancer and ACP.
Procedures
Focus groups were structured using stimulus materials based on the Australian National Framework for ACP and guided by the AACTT framework. Maps of ACP behaviours were iteratively co-created and refined to reflect participant perspectives. Transcripts were deductively coded to AACTT domains and inductively analysed to identify behavioural themes. Provider and consumer maps were compared to assess alignment and divergence.
Results
Significant misalignments emerged between providers and consumers across the actor, context, and time domains of AACTT. These divergences were particularly evident at key touchpoints in the ACP process, including when and with whom conversations about care preferences should occur. While providers often associated ACP initiation with late-stage disease and medical specialists, consumers preferred earlier engagement, often at diagnosis or during routine care, and valued discussions led by nurses/legal professionals. Several important ACP actions were missing altogether, such as proactive revisiting of preferences. These misalignments highlighted critical, often overlooked opportunities to better support ACP engagement.
Conclusion and Clinical Implications
This is the first known application of AACTT to map both provider and consumer perspectives across a full care pathway. The method surfaced 'meta-barriers' not captured by traditional approaches, revealing disconnects between provider practices and patient expectations. The AACTT-informed approach offers a structured, replicable way to specify and compare stakeholder behaviours, informing development of patient-centred implementation strategies for ACP and other complex interventions.