Objectives Advance care planning is the process by which people reflect upon their wishes and values for healthcare, discuss their choices with family and friends and document their wishes. Readiness represents a key predictor of advance care planning participation; however, the evidence for addressing readiness is scarce within the renal failure context. Our objectives were to assess readiness for advance care planning and barriers and facilitators to advance care planning uptake in a renal context. Methods Twenty-five participants (nine patients, nine clinicians and seven family members) were recruited from the Southern Alberta Renal Program. Semi-structured interviews were recorded, transcribed and then analyzed using interpretive description. Results Readiness for advance care planning was driven by individual values perceived by a collaborative encounter between clinicians and patients/families. If advance care planning is not valued, then patients/families and clinicians are not ready to initiate the process. Patients and clinicians are delaying conversations until "illness burden necessitates," so there is little "advance" care planning, only care planning in-the-moment closer to the end of life. Discussion The value of advance care planning in collaboration with clinicians, patients and their surrogates needs reframing as an ongoing process early in the patient's illness trajectory, distinguished from end-of-life decision making.

The woman who spoke these words has died of cancer. The day she said this she had just learned that the cancer she had was incurable. I open with this account to introduce the concern and focus of my study. This is what I call the 'liminal space'. Jane* came to this space after being through the cancer treatment system, learning what it was to be a person with cancer, learning how to be a cancer patient with colon cancer, learning that the chemotherapy, surgery and radiation therapy she had could not rid her of her cancer, and now being faced with learning to be a person who would die of cancer.Liminality is a concept arising out of anthropology, describing a betwixt and between place and persona between a past and future state (Turner, 1969;van Gennep, 1960). Meyers (2008) explores liminality through the lens of existential philosophers Sartre and Merleau-Ponty's reflections on being and nothingness. Liminality is also taken up in sociology in terms of inter-polar spaces between cultures (Fanetti, 2005) and in thinking about porches as thresholds and transitioning spaces (Walker, 2005). Liminality is also explored in health care literature relating to chronic illness (Frankenberg, 1986), and as a space experienced by people facing life-limiting diseases (Bruce et al., in press). Finally, liminality is explored for people with cancer in terms of a process (Little, Jordens, Paul, Montgomery, & Philipson, 1998) and as a life-long way of being after being diagnosed with cancer (Navon & Morag, 2004).This study explores liminality as a particular space that opens up for some people leaving cancer treatment centres and, being faced with dying because of their cancer, how they go on. As a concept liminality is rooted in the betwixt/between living/dying and expressed by people like Jane, as an ambiguous space and self. I will also demonstrate that, in some particular and observable ways, it is a space shaped by the cancer treatment system and how people are constituted and constitute themselves as cancer patients and, subsequently, as dying persons. This will be carefully explored, as liminality itself is a rather ineffable concept, particularly as this applies to a dying person, and difficult to expose in an empirical manner. However, liminality is also a space that lies between two expert systems, and is, therefore, shaped by and experienced through how these systems are and how these systems are taken up by people who find (or lose) themselves in a liminal space. Therefore, while liminality is not a new term to be used in cancer or other life-limiting diseases, the ways in which liminality is positioned in this study are new territory for cancer palliative care research and nursing.

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