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Barriers to advance care planning in cancer, heart failure and dementia patients: a focus group study on general practitioners' views and experiences.
PLoS One. 2014; 9(1):e84905.Plos

Abstract

BACKGROUND

The long-term and often lifelong relationship of general practitioners (GPs) with their patients is considered to make them the ideal initiators of advance care planning (ACP). However, in general the incidence of ACP discussions is low and ACP seems to occur more often for cancer patients than for those with dementia or heart failure.

OBJECTIVE

To identify the barriers, from GPs' perspective, to initiating ACP and to gain insight into any differences in barriers between the trajectories of patients with cancer, heart failure and dementia.

METHOD

Five focus groups were held with GPs (n = 36) in Flanders, Belgium. The focus group discussions were transcribed verbatim and analyzed using the method of constant comparative analysis.

RESULTS

THREE TYPES OF BARRIERS WERE DISTINGUISHED: barriers relating to the GP, to the patient and family and to the health care system. In cancer patients, a GP's lack of knowledge about treatment options and the lack of structural collaboration between the GP and specialist were expressed as barriers. Barriers that occured more often with heart failure and dementia were the lack of GP familiarity with the terminal phase, the lack of key moments to initiate ACP, the patient's lack of awareness of their diagnosis and prognosis and the fact that patients did not often initiate such discussions themselves. The future lack of decision-making capacity of dementia patients was reported by the GPs as a specific barrier for the initiation of ACP.

CONCLUSION

The results of our study contribute to a better understanding of the factors hindering GPs in initiating ACP. Multiple barriers need to be overcome, of which many can be addressed through the development of practical guidelines and educational interventions.

Authors+Show Affiliations

End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium.End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium.End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium.End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium.End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium.LUCAS (Center for Care Research and Consultancy), Catholic University of Louvain, Louvain, Belgium.End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium ; Department of Public and Occupational Health, and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium ; Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24465450

Citation

De Vleminck, Aline, et al. "Barriers to Advance Care Planning in Cancer, Heart Failure and Dementia Patients: a Focus Group Study On General Practitioners' Views and Experiences." PloS One, vol. 9, no. 1, 2014, pp. e84905.
De Vleminck A, Pardon K, Beernaert K, et al. Barriers to advance care planning in cancer, heart failure and dementia patients: a focus group study on general practitioners' views and experiences. PLoS ONE. 2014;9(1):e84905.
De Vleminck, A., Pardon, K., Beernaert, K., Deschepper, R., Houttekier, D., Van Audenhove, C., Deliens, L., & Vander Stichele, R. (2014). Barriers to advance care planning in cancer, heart failure and dementia patients: a focus group study on general practitioners' views and experiences. PloS One, 9(1), e84905. https://doi.org/10.1371/journal.pone.0084905
De Vleminck A, et al. Barriers to Advance Care Planning in Cancer, Heart Failure and Dementia Patients: a Focus Group Study On General Practitioners' Views and Experiences. PLoS ONE. 2014;9(1):e84905. PubMed PMID: 24465450.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Barriers to advance care planning in cancer, heart failure and dementia patients: a focus group study on general practitioners' views and experiences. AU - De Vleminck,Aline, AU - Pardon,Koen, AU - Beernaert,Kim, AU - Deschepper,Reginald, AU - Houttekier,Dirk, AU - Van Audenhove,Chantal, AU - Deliens,Luc, AU - Vander Stichele,Robert, Y1 - 2014/01/21/ PY - 2013/07/15/received PY - 2013/11/28/accepted PY - 2014/1/28/entrez PY - 2014/1/28/pubmed PY - 2014/10/28/medline SP - e84905 EP - e84905 JF - PloS one JO - PLoS ONE VL - 9 IS - 1 N2 - BACKGROUND: The long-term and often lifelong relationship of general practitioners (GPs) with their patients is considered to make them the ideal initiators of advance care planning (ACP). However, in general the incidence of ACP discussions is low and ACP seems to occur more often for cancer patients than for those with dementia or heart failure. OBJECTIVE: To identify the barriers, from GPs' perspective, to initiating ACP and to gain insight into any differences in barriers between the trajectories of patients with cancer, heart failure and dementia. METHOD: Five focus groups were held with GPs (n = 36) in Flanders, Belgium. The focus group discussions were transcribed verbatim and analyzed using the method of constant comparative analysis. RESULTS: THREE TYPES OF BARRIERS WERE DISTINGUISHED: barriers relating to the GP, to the patient and family and to the health care system. In cancer patients, a GP's lack of knowledge about treatment options and the lack of structural collaboration between the GP and specialist were expressed as barriers. Barriers that occured more often with heart failure and dementia were the lack of GP familiarity with the terminal phase, the lack of key moments to initiate ACP, the patient's lack of awareness of their diagnosis and prognosis and the fact that patients did not often initiate such discussions themselves. The future lack of decision-making capacity of dementia patients was reported by the GPs as a specific barrier for the initiation of ACP. CONCLUSION: The results of our study contribute to a better understanding of the factors hindering GPs in initiating ACP. Multiple barriers need to be overcome, of which many can be addressed through the development of practical guidelines and educational interventions. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/24465450/Barriers_to_advance_care_planning_in_cancer_heart_failure_and_dementia_patients:_a_focus_group_study_on_general_practitioners'_views_and_experiences_ L2 - http://dx.plos.org/10.1371/journal.pone.0084905 DB - PRIME DP - Unbound Medicine ER -