Advance care planning for patients with cancer in the palliative phase in Dutch general practices

Abstract

Background Advance care planning (ACP) is a crucial element of palliative care. It improves the quality of end-of-life care and reduces aggressive and needless life-prolonging medical interventions. However, little is known about its application in daily practice. This study aims to examine the application of ACP for patients with cancer in general practice. Methods We performed a retrospective cohort study in 11 general practices in the Netherlands. Electronic patient records (EPRs) of deceased patients with colorectal or lung cancer were analysed. Data on ACP documentation, correspondence between medical specialist and GP, and health care use in the last year of life were extracted. Results Records of 163 deceased patients were analysed. In 74% of the records, one or more ACP items were registered. GPs especially documented patients’ preferences for euthanasia (58%), palliative sedation (46%) and preferred place of death (26%). Per patient, GPs received on average six letters from medical specialists. These letters mainly contained information regarding medical treatment and rarely ACP items. In the last year of life, patients contacted the GP over 30 times, and 51% visited the emergency department at least once, of whom 54% in the last month. Conclusions Registration of ACP items in GPs’ EPRs appeared to be limited. ACP elements were rarely subject of communication between primary and secondary care, which may impact the continuity of patient care during the last year of life. More emphasis on registration of ACP items and better exchange of information regarding patients’ preferences are needed.

Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

“…Cancer‐related issues and appropriate treatment possibilities involved all relevant issues as the person's state of health alters (Samara et al, 2013), such as information on disease trajectory (Bires et al, 2018), “incurable disease” (Tokito et al, 2015), prognosis (Boyd et al, 2010) as well as expected effects of disease on symptoms and quality of life (Bickel et al, 2016). Information about future care (Boyd et al, 2010) included areas such as treatment possibilities concerning reasonable treatment options (Bires et al, 2018), expectations for disease control (Bickel et al, 2016) and policies regarding referral, hospitalisation and intensive care (Ermers et al, 2019).…”

“…Orders regarding life‐sustaining treatment— in other words, restrictions placed on the care provided (Hirvonen et al, 2018)—included orders regarding medical treatment (Ermers et al, 2019). They were advance directives (Bickel et al, 2016; Bires et al, 2018; Hu et al, 2010; Obel et al, 2014; Zhou et al, 2010), Physician Orders for Life‐Sustaining Treatment (POLST) (Zhou et al, 2010) and code status orders (Bickel et al, 2016; Obel et al, 2014; Thomas et al, 2019).…”

“…They were advance directives (Bickel et al, 2016; Bires et al, 2018; Hu et al, 2010; Obel et al, 2014; Zhou et al, 2010), Physician Orders for Life‐Sustaining Treatment (POLST) (Zhou et al, 2010) and code status orders (Bickel et al, 2016; Obel et al, 2014; Thomas et al, 2019). They determine the type of emergent treatment a patient would or would not receive if their breathing or heart were to stop, such as decision on resuscitation (Bickel et al, 2016; Ermers et al, 2019; Hirvonen et al, 2018; Obel et al, 2014; Seymour et al, 2010; Tokito et al, 2015).…”

“…Alleviation of suffering contained issues related to alleviation of suffering, such as preferences for palliative care (Zhou et al, 2010), documenting encounter for palliative care with ICD‐10 code Z51.5 (palliative care) (Hirvonen et al, 2018), euthanasia, palliative sedation (Ermers et al, 2019) and hospice care (Ermers et al, 2019; Thomas et al, 2019; Zhou et al, 2010).…”

“…Preferred place of death references were home (Boyd et al, 2010; Thomas et al, 2019) and nursing care home (Seymour et al, 2010) and were connected with impending death (Ermers et al, 2019).…”