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Aim To explore the factors that influence Queensland public hospital doctors’ application of ACPs.Background Healthcare consumers are often encouraged to develop an ACP to help to ensure their preferences are known and respected. However, the factors associated with doctors’ non/application of patient-owned ACPs (Advance Health Directives and Statement of Choices Form A) remain to be better understood.Methods Constructivist grounded theory methodology was used to inductively describe experiences of doctors, allied health clinicians, nurses, family/friends and people with a neurodegenerative illness who had completed an ACP. Multisite approvals were granted by Townsville Hospital and Health Service Human Research Ethics Committee and James Cook University. Semi-structured interviews were conducted between November 2019 and November 2020. Interviews were transcribed, coded and analysed.Results Participants: 16 public hospital doctors, 10 allied health clinicians, 6 nurses and 13 consumers. Analysis revealed two overarching themes: Human Factors and Systemic Factors. Human factors were Conflicting Interests, and shared decision-making through Relational Autonomy (partnerships with family). Systemic factors included matters of Law, and Delegitimisation of patient-owned ACPs.Discussion Applying an ACP is a complex and challenging human experience. Doctors seek to provide good medical care which they believe is in patients’ ‘best interests’. To do this, they discern a temporal medical plan, often without consulting the ACP. Doctors asserted that families engage on behalf of patients and that doctors are under-resourced and inadequately trained to support patient-owned ACP. Instead, they described Queensland Health’s Acute Resuscitation Plan as the ACP most relevant to inpatients.An individual’s power to retain a voice through ACP is diffused upon entry into the public hospital system. The application of ACP is dependent on doctors’ willingness to partner with patients through a written document. This research concluded that doctors typically partner with families in a relational autonomy practice when the medical facts are most clear and agreement can be achieved. Doctors consider this form of shared decision-making reduces risks to both patient and family’s current best interests. ACPs were thought useful to help settle disputes, or when no family was available. Ultimately, doctors determine what influence, if any, ACPs have.Unique Contribution This research reports on factors associated with Queensland’s public healthcare system’s considerable influence over the non/application of ACPs.Implications Healthcare system managers bear responsibilities for developing and implementing policies to ensure clinicians are familiar with the law and the application of ACP.