Primary care physicians’ perceptions on advance care planning before and during the COVID-19 pandemic

Abstract

<h3>Context:</h3> Advance care planning (ACP) in primary care has become increasingly important during the COVID-19 pandemic. The pandemic has introduced a surge in the risk of morbidity and mortality of previously at-risk patients, creating pressure on the healthcare system and instigating an urgent need to improve ACP communication in primary care within the community. An increase in the advocacy of ACP along with a growing public interest may facilitate more patient engagement in ACP discussions with their healthcare provider. <h3>Objective:</h3> To assess knowledge, attitudes, and practices (KAP) of family physicians relating to ACP before the COVID-19 pandemic and after a city-wide ACP campaign. The perception and use of telemedicine to conduct ACP discussions was also assessed. <h3>Study Design:</h3> Quasi-experimental quality improvement study with a cross-sectional online survey administered from March to May 2020. <h3>Setting:</h3> Community based in Hamilton, Ontario (Canada). <h3>Population Studied:</h3> Family physicians working in Hamilton, as part of the Hamilton Family Medicine (HFAM) network which consists of approximately 350 physicians. 48 of 350 family physicians (14%) responded. <h3>Outcome Measures:</h3> Mean ratings on questions of KAP relating to ACP for three months preceding and following the onset of the pandemic, use of telemedicine for ACP discussions, and the perceived impact of web-based ACP resources. <h3>Results:</h3> On average, physicians felt ACP was beneficial to patients, both pre- and post-onset of COVID-19 pandemic. There was a significant increase in use of telemedicine to discuss ACP during the pandemic (mean 1.9 [a little] to 2.9 [somewhat] p&lt;0.001). Most respondents (89%) rated the experience of telemedicine-based ACP as positive. However, most (80%) perceived in-person ACP conversations as better than virtual conversations. Most respondents (80%) reported the city-wide ACP initiative increased their frequency of ACP discussions, but the number of discussions reported pre- and post-onset of pandemic was marginally higher (mean 2.9 to 3.1). <h3>Conclusions:</h3> There was no significant change in family physicians’ reported KAP regarding ACP during the COVID-19 pandemic as compared to prior. The use of telemedicine to conduct ACP conversations increased but in-person discussions were favoured. A city-wide initiative to promote ACP, including web-based resources, demonstrated some benefit.