An Adult-Gerоntоlоgy Acute Cаre Nurse Prаctitioner (AGACNP) is cаring for a hospitalized older adult with newly diagnosed metastatic cancer. The patient has limited health literacy, no interpreter despite limited English proficiency, and minimal family support. During goals-of-care discussions, the patient appears confused and struggles to make informed treatment decisions. According to the shared decision-making framework, which factor is best classified as a structural variable that may negatively influence decision-making outcomes?