Australas J Ageing. 2019;1–9. wileyonlinelibrary.com/journal/ajag | 1 © 2019 AJA Inc. 1 | INTRODUCTION 1.1 | Background Advance care planning (ACP) refers to “a process that sup- ports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care.” 1 The process of ACP is itera- tive and complex, involving the individual, family members, health professionals and aged care workers. It is an ongoing discussion regarding a person's preferences for care, includ- ing end-of-life care, and requires regular review. ACP dis- cussions may lead to documentation of a person's preferences in an advance care directive, or appointment of a substitute decision-maker (SDM). Although ACP can be initiated in various settings, there is increased interest in implementation of ACP in aged care, where chronic illness means that an older person has a higher risk of losing the ability to make or communicate preferences. The current body of evidence demonstrates the benefits of ACP. ACP results in higher aged care staff satisfaction, 2 reduces unwanted hospitalisation and aggressive treat- ments, 3-5 reduces stress and anxiety for family members in decision-making and increases family member's satisfaction with outcomes at death. 6,7 Documented advance care plans also increase adherence to a person's preferences by health Received: 21 August 2018 | Revised: 7 February 2019 | Accepted: 17 February 2019 DOI: 10.1111/ajag.12639 REVIEW ARTICLE Facilitators and barriers to advance care planning implementation in Australian aged care settings: A systematic review and thematic analysis Frances Batchelor 1 | Kerry Hwang 1 | Betty Haralambous 1 | Marcia Fearn 1 | Paulene Mackell 1 | Linda Nolte 2 | Karen Detering 2,3 1 National Ageing Research Institute, Parkville, Victoria, Australia 2 Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia 3 Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, Victoria, Australia Correspondence Dr Frances Batchelor, National Ageing Research Institute, Parkville, Vic., Australia. Email: f.batchelor@nari.edu.au Funding information Department of Health, Australian Government Objectives: There are many studies investigating implementation of advance care planning (ACP) in aged care around the world, but few studies have investigated Australian settings. The objective of this study was to determine facilitators and bar- riers to implementation of ACP in Australian residential and community aged care. Methods: Evidence from Australian studies published between 2007 and September 2017 of ACP in residential and community aged care was sourced from electronic databases using predetermined search strategies. Data were extracted and synthe- sised using thematic analysis, and summarised according to themes. Results: Nine studies described facilitators and barriers of ACP implementation. Six themes were identified: “Education and Knowledge,” “Skills and Training,” “Procedures and Resources,” “Perceptions and Culture,” “Legislation” and “Systems.” Conclusions: A whole of systems approach is necessary to facilitate uptake of ACP in residential aged care settings. More research is needed to understand facilitators and barriers to ACP in community aged care. KEYWORDS advance care planning, aging, Australia, nursing homes, review