Two Approaches to Advance Care Planning for People with Dementia: Acceptability among US and Dutch Healthcare Providers

Abstract

AbstractBackgroundAdvance care planning (ACP) may include concrete treatment orders or important goals or both. Providers may differ on these approaches to ACP, which may also differ across countries. We investigated the acceptability and preferences for these two ACP approaches for people with dementia among healthcare providers from the Netherlands (NL) and the US.MethodFifty providers from each country, whose specialty includes providing end‐of‐life care for people with dementia, viewed short animation videos about the two approaches of ACP and completed a semi‐structured interview. Qualitative content analysis summarized the comments of the providers on each ACP approach (reasons and conditions for acceptability, (dis)advantages, barriers and facilitators), and the reasons for their preferences.ResultExcept for three nurse practitioners from the US, all participants were physicians (e.g., NL: elderly care physicians, family physicians; US: geriatricians, internists, family medicine physicians). The acceptability and preferences were similar in the two countries. Both approaches were considered acceptable for people with dementia by the vast majority of providers (concrete orders approach: 86% (both countries); important goals approach: 96% (NL) and 98% (US)). Slightly more providers preferred the important goals approach compared to the concrete one (NL: 42% vs. 34%; US: 46% vs. 36%), others had no preference. While the concrete approach may facilitate immediate decisions in emergent situations and may be easier for providers to conduct with available forms, the important goals approach takes the life view of the person with dementia into consideration, can be implemented in more situations and may be easier for the person with dementia. Differences between the two countries included the role of the family caregivers and the power of providers to make decisions.ConclusionProviders found both approaches acceptable, but there was diversity in the preferred approach in both countries. Future research should investigate how the preference of individual providers interacts with the preferences of people with dementia and family caregivers, and whether this influences the experience of ACP and subsequent care provision. Examining administrative, legal, and educational issues that may shape preferences may inform more patient‐centered ACP.