O’Halloran P, et al. - Considering the recommendations for implementing advance care planning for patients with end-stage kidney disease, a realist review was conducted to identify factors affecting its implementation. Researchers examined the implementation theories and developed a theory on how the intervention may work. Following factors were identified hindering advance care planning: lack of training; administrative complexities; pressures of routine care; patients overestimating life-expectancy; and when patients, family, and/or clinical staff are reluctant to initiate discussions. Higher probability for its successful implementation is expected where organizations treat it as core business; when the process is culturally appropriate and takes account of patient perceptions; and when patients are willing to consider death and dying with suitably trained staff.