Evaluation of a process to implement advance care planning conversations in primary care: uptake and patient experience

ABSTRACT

Objective Advance care planning (ACP) can support patients in achieving current and future medical care that aligns with their values and goals. In primary care, a lack of standardized processes hinders implementation of ACP conversations. This study reports a quality improvement process to identify and engage patients and clinicians in ACP.

Methods Primary care clinicians received training in conversations based on the Serious Illness Conversation Guide and tools to support ACP. In December 2019, patients 65 years of age and older with chronic obstructive pulmonary disease were systematically identified, mailed ACP resources and telephoned by the clinic to invite them to an ACP appointment. We tracked the attendance of the patients and evaluated patient experience using a survey.

Results Of the 91 patients telephoned, 50 were reached, and 27 attended the appointment. Further efforts were suspended in March 2020 due to the COVID-19 pandemic. Thirteen patients completed the survey. There were statistically significant increases in the patient’s perception of being heard and understood by their physician, feeling hopeful about quality of life and feeling peaceful.

Conclusion This study provides evidence that with training, tools and processes, patients and primary care clinicians can be effectively engaged in ACP conversations.

What was already known?

Training resources exist for help clinicians enhance their advance care planning communication skills

Besides a need for skills, other practical challenges exist in implementing advance care planning in family practice

What are the new findings?

Structured patient identification and preparation can facilitate advance care planning conversations in family practice

Patients reported positive experiences of the conversations

What is their significance?

Clinical: It is important to move beyond clinician training alone to implement processes in family practice to trigger advance care planning conversations

Research: Further research to identify effective scalable approaches to triggering and implementing advance care planning conversations in family practice would be beneficial

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study was funded by McMaster University Department of Family Medicine Pilot Research Funds and the Canadian Frailty Network (Technology Evaluation in the Elderly Network), which is supported by the Government of Canada through the Networks of Centres of Excellence (NCE) program.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Hamilton Integrated Research Ethics Board of McMaster University gave ethical approval for this work

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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