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Advance care planning conversations with palliative patients: looking through the GP's eyes.
BMC Fam Pract. 2018 11 28; 19(1):184.BF

Abstract

BACKGROUND

Although it is often recommended that general practitioners (GPs) initiate advance care planning (ACP), little is known about their experiences with ACP. This study aimed to identify GP experiences when conducting ACP conversations with palliative patients, and what factors influence these experiences.

METHODS

Dutch GPs (N = 17) who had participated in a training on timely ACP were interviewed. Data from these interviews were analysed using direct content analysis.

RESULTS

Four themes were identified: ACP and society, the GP's perceived role in ACP, initiating ACP and tailor-made ACP. ACP was regarded as a 'hot topic'. At the same time, a tendency towards a society in which death is not a natural part of life was recognized, making it difficult to start ACP discussions. Interviewees perceived having ACP discussions as a typical GP task. They found initiating and timing ACP easier with proactive patients, e.g. who are anxious of losing capacity, and much more challenging when it concerned patients with COPD or heart failure. Patients still being treated in hospital posed another difficulty, because they often times are not open to discussion. Furthermore, interviewees emphasized that taking into account changing wishes and the fact that not everything can be anticipated, is of the utmost importance. Moreover, when patients are not open to ACP, at a certain point it should be granted that choosing not to know, for example about where things are going or what possible ways of care planning might be, is also a form of autonomy.

CONCLUSIONS

ACP currently is a hot topic, which has favourable as well as unfavourable effects. As GPs experience difficulties in initiating ACP if patients are being treated in the hospital, future research could focus on a multidisciplinary ACP approach and the role of medical specialists in ACP. Furthermore, when starting ACP with palliative patients, we recommend starting with current issues. In doing so, a start can be made with future issues kept in view. Although the tension between ACP's focus on the patient's direction and the right not to know can be difficult, ACP has to be tailored to each individual patient.

Authors+Show Affiliations

Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands. Anne.Wichmann@radboudumc.nl.Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands.Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands.Section Ethics, University Kampen, Kampen, The Netherlands.Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands.Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands.

Pub Type(s)

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

Language

eng

PubMed ID

30486774

Citation

Wichmann, Anne B., et al. "Advance Care Planning Conversations With Palliative Patients: Looking Through the GP's Eyes." BMC Family Practice, vol. 19, no. 1, 2018, p. 184.
Wichmann AB, van Dam H, Thoonsen B, et al. Advance care planning conversations with palliative patients: looking through the GP's eyes. BMC Fam Pract. 2018;19(1):184.
Wichmann, A. B., van Dam, H., Thoonsen, B., Boer, T. A., Engels, Y., & Groenewoud, A. S. (2018). Advance care planning conversations with palliative patients: looking through the GP's eyes. BMC Family Practice, 19(1), 184. https://doi.org/10.1186/s12875-018-0868-5
Wichmann AB, et al. Advance Care Planning Conversations With Palliative Patients: Looking Through the GP's Eyes. BMC Fam Pract. 2018 11 28;19(1):184. PubMed PMID: 30486774.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance care planning conversations with palliative patients: looking through the GP's eyes. AU - Wichmann,Anne B, AU - van Dam,Hanna, AU - Thoonsen,Bregje, AU - Boer,Theo A, AU - Engels,Yvonne, AU - Groenewoud,A Stef, Y1 - 2018/11/28/ PY - 2018/08/09/received PY - 2018/11/13/accepted PY - 2018/11/30/entrez PY - 2018/11/30/pubmed PY - 2019/9/24/medline KW - Advance care planning KW - General practice KW - Palliative medicine KW - Qualitative research SP - 184 EP - 184 JF - BMC family practice JO - BMC Fam Pract VL - 19 IS - 1 N2 - BACKGROUND: Although it is often recommended that general practitioners (GPs) initiate advance care planning (ACP), little is known about their experiences with ACP. This study aimed to identify GP experiences when conducting ACP conversations with palliative patients, and what factors influence these experiences. METHODS: Dutch GPs (N = 17) who had participated in a training on timely ACP were interviewed. Data from these interviews were analysed using direct content analysis. RESULTS: Four themes were identified: ACP and society, the GP's perceived role in ACP, initiating ACP and tailor-made ACP. ACP was regarded as a 'hot topic'. At the same time, a tendency towards a society in which death is not a natural part of life was recognized, making it difficult to start ACP discussions. Interviewees perceived having ACP discussions as a typical GP task. They found initiating and timing ACP easier with proactive patients, e.g. who are anxious of losing capacity, and much more challenging when it concerned patients with COPD or heart failure. Patients still being treated in hospital posed another difficulty, because they often times are not open to discussion. Furthermore, interviewees emphasized that taking into account changing wishes and the fact that not everything can be anticipated, is of the utmost importance. Moreover, when patients are not open to ACP, at a certain point it should be granted that choosing not to know, for example about where things are going or what possible ways of care planning might be, is also a form of autonomy. CONCLUSIONS: ACP currently is a hot topic, which has favourable as well as unfavourable effects. As GPs experience difficulties in initiating ACP if patients are being treated in the hospital, future research could focus on a multidisciplinary ACP approach and the role of medical specialists in ACP. Furthermore, when starting ACP with palliative patients, we recommend starting with current issues. In doing so, a start can be made with future issues kept in view. Although the tension between ACP's focus on the patient's direction and the right not to know can be difficult, ACP has to be tailored to each individual patient. SN - 1471-2296 UR - https://www.unboundmedicine.com/medline/citation/30486774/Advance_care_planning_conversations_with_palliative_patients:_looking_through_the_GP's_eyes_ L2 - https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-018-0868-5 DB - PRIME DP - Unbound Medicine ER -