The perspectives on advance care planning of older people with psychotic illnesses and their carers.

Purpose: To examine the attitudes, experiences, and perceived facilitators and barriers to Advance Care Planning (ACP), of older people with schizophrenia and other psychotic illness and their carers.

Methods: Older people with a psychotic illness and carers were recruited from public mental health services in Sydney, Australia. Semi-structured interviews to explore attitudes, experiences, and perceived barriers and facilitators to ACP were conducted by an external clinician. Consumers' medical, psychiatric and drug health diagnoses were recorded and they completed cognitive and symptom rating scales. Reflexive thematic analysis was used to analyse the transcripts of interviews, within an interpretive description framework.

Results: Thematic saturation was achieved with 12 consumers and 5 carers. Emergent themes from consumer interviews were (i) 'What is ACP?'; (ii) 'I have not done ACP because…..'; (iii) 'I want to do ACP'; (iv) 'If I was to do ACP I would need..'; and (v) 'Mental health clinicians have the skills to help me with ACP'. Carer themes included (i) 'We do not participate in ACP', (ii) 'I want to participate in ACP', and (iii) 'Key clinician skills are needed'. There was convergence of themes from both groups.

Conclusion: This study demonstrates that older people with a psychotic illness can express views regarding ACP, despite ongoing symptoms of psychosis, cognitive impairment and mild-moderate severity of illness. The emergent themes highlight opportunities to intervene to overcome barriers to ACP, including education for both participant groups and clinicians, practical considerations and the need for all to collaborate, including with primary care.