Advance care planning for cancer patients in primary care: a feasibility study

Abstract

Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging. AimTo assess the feasibility of implementing advance care planning in UK primary care. Design of studyMixed methods evaluation of a pilot educational intervention. SettingFour general practices in south-east Scotland. MethodInterviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK. ResultsEnd-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a 'good death'. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of 'tick-box' approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care. ConclusionA clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes. Keywordsadvance care planning; cancer; palliative care; primary health care. INTRODUCTIONAdvance care planning is viewed as an intrinsic component of end-of-life care programmes in many developed countries. In the US, advance directives were originally intended to allow people to record an advance refusal of invasive, life-prolonging interventions.1 The limitations of this approach resulted in a progressive move internationally towards a broader process of advance care planning that also includes discussion of personal goals, wishes, and preferences about future care. [2][3][4] Programmes in the US and Australia that have adopted a regional strategy towards educating professionals, patients, and the general public about advance care planning have had some success. 5,6 Proactive care planning is central to recent UK policies, and the expectation is that it will now be offered to all patients approaching the end of life.

Advance Care Planning Does Not Adversely Affect Hope or Anxiety Among Patients With Advanced Cancer

“…This should reassure clinicians that helping patients prepare for the future is not at odds with preserving hope, even among patients with life-threatening illnesses such as cancer. 23,60 Taken in conjunction with research showing that honest prognostic information does not diminish hope, 61 it is reasonable to conclude that clinicians need not avoid end-of-life preparation out of a concern for the patient's well-being, and indeed can confidently engage patients in this important activity.…”

Comorbidity and favorable neurologic outcome after out-of-hospital cardiac arrest in patients of 70 years and older

“…Advance care planning is a process in which patients are informed and empowered to express their wishes and goals for their current and future treatment. 7,8 Previous studies on survival and neurologic outcome of CPR attempts after OHCA show varying results, differing per country, region and study period. [9][10][11][12][13][14][15][16][17] Also, most studies on outcome have been performed in the general population, of which older patients http://dx.doi.org/10.1016/j.resuscitation.2015.06.017 0300-9572/© 2015 Elsevier Ireland Ltd. All rights reserved.…”

Planning for tomorrow whilst living for today: the views of people with dementia and their families on advance care planning

“…Advance care planning (ACP) is an example of one such policy. The origins of ACP can be traced back to the development of advance directives in the United States: these were initially termed "living wills" and allowed people to refuse in advance invasive life-prolonging treatments (Patient Self Determination Act: 1990;Boyd et al, 2010).…”