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Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners.
BMJ Open. 2018 11 25; 8(11):e024762.BO

Abstract

OBJECTIVES

Advance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice.

DESIGN, SETTING AND PARTICIPANTS

A qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews.

RESULTS

Approaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive geriatric assessments and periodic assessments. Meetings were aimed at making agreements in anticipation of future care, at providing information and encouraging older people to take further steps in ACP. With ad hoc approaches, respondents discussed only one or two topics related to the near future. Ad hoc ACP was mainly done with deteriorating patients or when patients or family initiated ACP. Systematic and ad hoc approaches were used simultaneously or sequentially and were both used for initiating and following up on ACP. Due to a lack of time and knowledge of other occasions and topics than the ones respondents used, respondents seemed to underuse many occasions and topics.

CONCLUSIONS

Awareness of appropriate systematic and ad hoc approaches for ACP, and the focus on providing information and encouraging older people to take further steps in ACP reported in this study can support GPs and improve older patients' access to ACP.

Authors+Show Affiliations

Section of Medical Ethics, Department of General Practice, Amsterdam Public Health research institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands.Department of General Practice, Academic Medical Centre-University of Amsterdam-Amsterdam Public Health research institute, Amsterdam, The Netherlands.Department of General Practice, Academic Medical Centre-University of Amsterdam-Amsterdam Public Health research institute, Amsterdam, The Netherlands.Huisartsenpraktijk Kerkelanden, Hilversum, The Netherlands.Section of Medical Ethics, Department of General Practice, Amsterdam Public Health research institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands.

Pub Type(s)

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

Language

eng

PubMed ID

30478126

Citation

Glaudemans, Jolien Jeltje, et al. "Experiences With Approaches to Advance Care Planning With Older People: a Qualitative Study Among Dutch General Practitioners." BMJ Open, vol. 8, no. 11, 2018, pp. e024762.
Glaudemans JJ, Moll van Charante E, Wind J, et al. Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners. BMJ Open. 2018;8(11):e024762.
Glaudemans, J. J., Moll van Charante, E., Wind, J., Oosterink, J. J., & Willems, D. L. (2018). Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners. BMJ Open, 8(11), e024762. https://doi.org/10.1136/bmjopen-2018-024762
Glaudemans JJ, et al. Experiences With Approaches to Advance Care Planning With Older People: a Qualitative Study Among Dutch General Practitioners. BMJ Open. 2018 11 25;8(11):e024762. PubMed PMID: 30478126.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners. AU - Glaudemans,Jolien Jeltje, AU - Moll van Charante,Eric, AU - Wind,Jan, AU - Oosterink,John Jacob, AU - Willems,Dick Ludolf, Y1 - 2018/11/25/ PY - 2018/11/28/entrez PY - 2018/11/28/pubmed PY - 2019/10/28/medline KW - advance care planning KW - general practice KW - geriatric medicine SP - e024762 EP - e024762 JF - BMJ open JO - BMJ Open VL - 8 IS - 11 N2 - OBJECTIVES: Advance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice. DESIGN, SETTING AND PARTICIPANTS: A qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews. RESULTS: Approaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive geriatric assessments and periodic assessments. Meetings were aimed at making agreements in anticipation of future care, at providing information and encouraging older people to take further steps in ACP. With ad hoc approaches, respondents discussed only one or two topics related to the near future. Ad hoc ACP was mainly done with deteriorating patients or when patients or family initiated ACP. Systematic and ad hoc approaches were used simultaneously or sequentially and were both used for initiating and following up on ACP. Due to a lack of time and knowledge of other occasions and topics than the ones respondents used, respondents seemed to underuse many occasions and topics. CONCLUSIONS: Awareness of appropriate systematic and ad hoc approaches for ACP, and the focus on providing information and encouraging older people to take further steps in ACP reported in this study can support GPs and improve older patients' access to ACP. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/30478126/Experiences_with_approaches_to_advance_care_planning_with_older_people:_a_qualitative_study_among_Dutch_general_practitioners_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=30478126 DB - PRIME DP - Unbound Medicine ER -