Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

ObjectivesAdvance 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 participantsA qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews.ResultsApproaches 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.ConclusionsAwareness 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.

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P35 Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

10.1136/spcare-2019-acpicongressabs.119 ◽

2019 ◽

Author(s):

J Glaudemans ◽

E Moll van Charante ◽

J Wind ◽

J Oosterink ◽

D Willems

Keyword(s):

Qualitative Study ◽

Older People ◽

General Practitioners ◽

Advance Care Planning ◽

Care Planning ◽

Advance Care

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How Do General Practitioners Conceptualise Advance Care Planning in Their Practice? A Qualitative Study

PLoS ONE ◽

10.1371/journal.pone.0153747 ◽

2016 ◽

Vol 11 (4) ◽

pp. e0153747 ◽

Cited By ~ 16

Author(s):

Aline De Vleminck ◽

Koen Pardon ◽

Kim Beernaert ◽

Dirk Houttekier ◽

Robert Vander Stichele ◽

...

Keyword(s):

Qualitative Study ◽

General Practitioners ◽

Advance Care Planning ◽

Care Planning ◽

Advance Care

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Preventing unwanted situations and gaining trust: a qualitative study of older people and families’ experiences with advance care planning in the daily practice of primary care

Family Practice ◽

10.1093/fampra/cmz089 ◽

2019 ◽

Vol 37 (4) ◽

pp. 519-524

Author(s):

Jolien J Glaudemans ◽

Dick L Willems ◽

Jan Wind ◽

Bregje D Onwuteaka Philipsen

Keyword(s):

Primary Care ◽

Older People ◽

Advance Care Planning ◽

Daily Practice ◽

Care Planning ◽

Theory Approach ◽

Face To Face ◽

Future Care ◽

Advance Care

Abstract Background Using advance care planning (ACP) to anticipate future decisions can increase compliance with people’s end-of-life wishes, decrease inappropriate life-sustaining treatment and reduce stress, anxiety and depression. Despite this, only a minority of older people engage in ACP, partly because care professionals lack knowledge of approaches towards ACP with older people and their families. Objective To explore older people’s and their families’ experiences with ACP in primary care. Methods We conducted qualitative, semi-structured, face-to-face interviews with 22 older people (aged >70 years, v/m: 11/11), with experience in ACP, and eight of their family members (aged 40–79 years, f/m: 7/1). Transcripts were inductively analysed using a grounded theory approach. Results We distinguished three main themes. (i) Openness and trust: Respondents were more open to ACP if they wanted to prevent specific future situations and less open if they lacked trust or had negative thoughts regarding general practitioners’ (GPs’) time for and interest in ACP. Engaging in ACP appeared to increase trust. (ii) Timing and topics: ACP was not initiated too early. Quality of ACP seemed to improve if respondents’ views on their current life and future, a few specific future care scenarios and expectations and responsibilities regarding ACP were discussed. (iii) Roles of family: Quality of ACP appeared to improve if family was involved in ACP. Conclusions Quality and accessibility of ACP may improve if GPs and nurses involve family, explain GPs’ interest in ACP and discuss future situations older people may want to prevent, and views on their current life and future.

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17 Conversations on Living and Dying: Facilitating Advance Care Planning for Older People Living with Frailty. A Qualitative Study

Age and Ageing ◽

10.1093/ageing/afab028.17 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i1-i6

Author(s):

S Combes ◽

C Nicholson ◽

K Gillett ◽

C Norton

Keyword(s):

Older People ◽

Advance Care Planning ◽

Behavioural Change ◽

Family Members ◽

Community Dwelling ◽

Care Planning ◽

Structured Interviews ◽

Living Well ◽

Advance Care ◽

Community Dwelling Older People

Abstract Introduction Advance care planning (ACP) is a process that supports people to articulate their future care preferences. This process is a priority for older people living with frailty due to their vulnerability to sudden deterioration, something that has been highlighted during the current pandemic. However, ACP is uncommon for older people living with frailty, hindering choice and person-centred end-of-life care. This study aimed to identify the barriers, facilitators and behaviours required to support cognitively-able, community-dwelling older people living with frailty to engage with ACP. Findings will inform the development an ACP intervention underpinned by behavioural change theory. Methods Semi-structured interviews with community-dwelling older people living with frailty (Clinical Frailty Score 6 or 7) and family members were audio-recorded, filmed and transcribed verbatim. A thematic analysis framework was developed using a recent systematic review, and expanded to reflect new themes. Results Ten older people living with frailty and eight family members were interviewed. The older people’s median age was 85 and seven were female. Family members were spouses (n = 4) and children (n = 4). The key findings were that: the meaning of ACP could be unclear and at times confusing; many of the older people believed ACP was not relevant to them; relationships and relational autonomy were of greater relevance to older people than autonomous decision-making; older people were more interested in living well now than in planning for the future. Conclusions Older people living with frailty need to be engaged with ACP in a way that helps them to understand what ACP is and why it is relevant for them. Professionals need to develop their skills in assessing readiness and facilitating ACP conversations with this population at the older person’s pace. Reframing ACP to include living well now alongside encouraging family inclusion would also relate better to this populations’ lives.

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