Abstract
BackgroundAlthough it is often recommended that general practitioners (GPs) initiate advance care planning (ACP), little is known about their experiences with ACP. This study aimed to identify GP experiences when conducting ACP conversations with palliative patients, and what factors influence these experiences.MethodsDutch GPs (N = 17) who had participated in a training on timely ACP were interviewed. Data from these interviews were analysed using direct content analysis.ResultsFour themes were identified: ACP and society, the GP’s perceived role in ACP, initiating ACP and tailor-made ACP. ACP was regarded as a ‘hot topic’. At the same time, a tendency towards a society in which death is not a natural part of life was recognized, making it difficult to start ACP discussions. Interviewees perceived having ACP discussions as a typical GP task. They found initiating and timing ACP easier with proactive patients, e.g. who are anxious of losing capacity, and much more challenging when it concerned patients with COPD or heart failure. Patients still being treated in hospital posed another difficulty, because they often times are not open to discussion. Furthermore, interviewees emphasized that taking into account changing wishes and the fact that not everything can be anticipated, is of the utmost importance. Moreover, when patients are not open to ACP, at a certain point it should be granted that choosing not to know, for example about where things are going or what possible ways of care planning might be, is also a form of autonomy.ConclusionsACP currently is a hot topic, which has favourable as well as unfavourable effects. As GPs experience difficulties in initiating ACP if patients are being treated in the hospital, future research could focus on a multidisciplinary ACP approach and the role of medical specialists in ACP. Furthermore, when starting ACP with palliative patients, we recommend starting with current issues. In doing so, a start can be made with future issues kept in view. Although the tension between ACP’s focus on the patient’s direction and the right not to know can be difficult, ACP has to be tailored to each individual patient.
Highlights
It is often recommended that general practitioners (GPs) initiate advance care planning (ACP), little is known about their experiences with ACP
Which is stimulating.’ (R4) Interviewees recognised a more proactive attitude in their patients, for example, when people are anxious about developing dementia or otherwise losing capacity. These patients according to interviewees sometimes have false expectations regarding ACP and the GP’s role in it, as if it were a matter of checking items off a list, it opens doors to discussion
ACP was regarded a ‘hot topic’, which was seen as a stimulator (GPs are more primed, patients are more proactive) as well as a barrier for timely initiation of ACP
Summary
It is often recommended that general practitioners (GPs) initiate advance care planning (ACP), little is known about their experiences with ACP. In addition to being an important means in extending patient autonomy, early initiation of ACP in palliative patients has been shown to improve patient and family satisfaction and quality of life (QoL) [3, 4], improve concordance between preferences for care and delivered care [5] and to be positively correlated with less aggressive care (such as ICU visits) [4, 6]. Despite these benefits, ACP is hardly undertaken in palliative patients in current practice [7,8,9]. This makes timely discussion of end-of-life (EoL) issues ever more important for patients, relatives and healthcare professional as well as society more broadly
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