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Development of a complex intervention to support the initiation of advance care planning by general practitioners in patients at risk of deteriorating or dying: a phase 0-1 study.
BMC Palliat Care. 2016 Feb 11; 15:17.BP

Abstract

BACKGROUND

Most patients with life-limiting illnesses are treated and cared for over a long period of time in primary care and guidelines suggest that ACP discussions should be initiated in primary care. However, a practical model to implement ACP in general practice is lacking. Therefore, the objective of this study is to develop an intervention to support the initiation of ACP in general practice.

METHODS

We conducted a Phase 0-I study according to the Medical Research Council (MRC) Framework. Phase 0 consisted of a systematic literature review about the barriers and facilitators for GPs to engage in ACP, focus groups with GPs were held about their experiences, attitudes and concerns regarding initiating ACP in general practice and a review of ACP interventions to identify potential components for the development of our intervention. In Phase 1, we developed a complex intervention to support the initiation of ACP in general practice in patients at risk of deteriorating or dying, based on the results of Phase 0. The complex intervention and its components were reviewed and refined by two expert panels.

RESULTS

Phase 0 resulted in the identification of the factors inhibiting or enabling GPs' initiation of ACP and important components underpinning existing ACP interventions. Based on these findings, an intervention was developed in Phase 1 consisting of: (1) a training for GPs in initiating and conducting ACP discussions, (2) a register of patients eligible for ACP discussions, (3) an educational booklet on ACP for patients to prepare the ACP discussions that includes general information on ACP, a section on the role of GPs in the process of ACP and a prompt list, (4) a conversation guide to support GPs in the ACP discussions and (5) a structured documentation template to record the outcomes of discussions.

CONCLUSION

Taking into account the barriers and facilitators for GPs to initiate ACP as well as the key factors underpinning successful ACP intervention in other health care settings, a complex intervention for general practice was developed, after gaining feedback from two expert panels. The feasibility and acceptability of the intervention will subsequently be tested in a Phase II study.

Authors+Show Affiliations

End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium. adevlemi@vub.ac.be.End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium.End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium. Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium. Heymans Institute, Ghent University, Ghent, Belgium.End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium. Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.

Pub Type(s)

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

Language

eng

PubMed ID

26868650

Citation

De Vleminck, Aline, et al. "Development of a Complex Intervention to Support the Initiation of Advance Care Planning By General Practitioners in Patients at Risk of Deteriorating or Dying: a Phase 0-1 Study." BMC Palliative Care, vol. 15, 2016, p. 17.
De Vleminck A, Houttekier D, Deliens L, et al. Development of a complex intervention to support the initiation of advance care planning by general practitioners in patients at risk of deteriorating or dying: a phase 0-1 study. BMC Palliat Care. 2016;15:17.
De Vleminck, A., Houttekier, D., Deliens, L., Vander Stichele, R., & Pardon, K. (2016). Development of a complex intervention to support the initiation of advance care planning by general practitioners in patients at risk of deteriorating or dying: a phase 0-1 study. BMC Palliative Care, 15, 17. https://doi.org/10.1186/s12904-016-0091-x
De Vleminck A, et al. Development of a Complex Intervention to Support the Initiation of Advance Care Planning By General Practitioners in Patients at Risk of Deteriorating or Dying: a Phase 0-1 Study. BMC Palliat Care. 2016 Feb 11;15:17. PubMed PMID: 26868650.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Development of a complex intervention to support the initiation of advance care planning by general practitioners in patients at risk of deteriorating or dying: a phase 0-1 study. AU - De Vleminck,Aline, AU - Houttekier,Dirk, AU - Deliens,Luc, AU - Vander Stichele,Robert, AU - Pardon,Koen, Y1 - 2016/02/11/ PY - 2015/06/17/received PY - 2016/02/08/accepted PY - 2016/2/13/entrez PY - 2016/2/13/pubmed PY - 2016/9/13/medline SP - 17 EP - 17 JF - BMC palliative care JO - BMC Palliat Care VL - 15 N2 - BACKGROUND: Most patients with life-limiting illnesses are treated and cared for over a long period of time in primary care and guidelines suggest that ACP discussions should be initiated in primary care. However, a practical model to implement ACP in general practice is lacking. Therefore, the objective of this study is to develop an intervention to support the initiation of ACP in general practice. METHODS: We conducted a Phase 0-I study according to the Medical Research Council (MRC) Framework. Phase 0 consisted of a systematic literature review about the barriers and facilitators for GPs to engage in ACP, focus groups with GPs were held about their experiences, attitudes and concerns regarding initiating ACP in general practice and a review of ACP interventions to identify potential components for the development of our intervention. In Phase 1, we developed a complex intervention to support the initiation of ACP in general practice in patients at risk of deteriorating or dying, based on the results of Phase 0. The complex intervention and its components were reviewed and refined by two expert panels. RESULTS: Phase 0 resulted in the identification of the factors inhibiting or enabling GPs' initiation of ACP and important components underpinning existing ACP interventions. Based on these findings, an intervention was developed in Phase 1 consisting of: (1) a training for GPs in initiating and conducting ACP discussions, (2) a register of patients eligible for ACP discussions, (3) an educational booklet on ACP for patients to prepare the ACP discussions that includes general information on ACP, a section on the role of GPs in the process of ACP and a prompt list, (4) a conversation guide to support GPs in the ACP discussions and (5) a structured documentation template to record the outcomes of discussions. CONCLUSION: Taking into account the barriers and facilitators for GPs to initiate ACP as well as the key factors underpinning successful ACP intervention in other health care settings, a complex intervention for general practice was developed, after gaining feedback from two expert panels. The feasibility and acceptability of the intervention will subsequently be tested in a Phase II study. SN - 1472-684X UR - https://www.unboundmedicine.com/medline/citation/26868650/Development_of_a_complex_intervention_to_support_the_initiation_of_advance_care_planning_by_general_practitioners_in_patients_at_risk_of_deteriorating_or_dying:_a_phase_0_1_study_ L2 - https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-016-0091-x DB - PRIME DP - Unbound Medicine ER -