Effectiveness of the ACA (Availability, Current issues and Anticipation) training programme on GP-patient communication in palliative care; a controlled trial

Slort, Willemjan; Blankenstein, Annette H.; Schweitzer, B.; Knol, Dirk L.; Deliens, Luc; Aaronson, Neil K.; Horst, Henriëtte E. van der

doi:10.1186/1471-2296-14-93

Cited by 12 publications

(14 citation statements)

References 21 publications

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“…The array of enablers identified in this study suggests that policy makers at a national level need to pay more attention to these topics and implement a comprehensive approach to improving the provision of palliative care which tackles difficult and costly issues, such as remuneration and workforce capacity. This contrasts with much of the previous intervention work aimed to improve palliative care provision which focusses heavily on single issues, such as GP knowledge [49, 50].…”

Section: Discussionmentioning

confidence: 91%

Australian GPs’ perceptions of barriers and enablers to best practice palliative care: a qualitative study

et al. 2019

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BackgroundGeneral Practitioners (GPs) often play an important role in caring for people at the end of life. While some international studies suggest that GPs experience a number of barriers to providing palliative care, little is known about views and experiences of GPs in Australia. This study explored Australian GPs’ perceptions of barriers and enablers to the provision of palliative care and provides new insights into how to implement best practice care at the end of life.MethodsThis was a qualitative study using 25 semi-structured phone interviews conducted with GPs practising in metropolitan and non-metropolitan New South Wales, Australia. Data were analysed using qualitative content analysis.ResultsGPs reported difficulties with palliative care provision due to i) the complex and often emotional nature of doctor-family-interaction; ii) a lack of evidence to guide care; and iii) the need to negotiate roles and responsibilities within the healthcare team. GPs listed a number of strategies to help deal with their workload and to improve communication processes between healthcare providers. These included appropriate scheduling of appointments, locally tailored mentoring and further education, and palliative care guidelines which more clearly outline the roles and responsibilities within multidisciplinary teams. GPs also noted the importance of online platforms to facilitate their communication with patients, their families and other healthcare providers, and to provide centralised access to locally tailored information on palliative care services. GPs suggested that non-government organisations could play an important role by raising awareness of the key role of GPs in palliative care provision and implementing an “official visitor” program, i.e. supporting volunteers to provide peer support or respite to people with palliative care needs and their families.ConclusionsThis study offers new insights into strategies to overcome well documented barriers to palliative care provision in general practice and help implement optimal care at the end of life. The results suggest that researchers and policy makers should adopt a comprehensive approach to improving the provision of palliative care which tackles the array of barriers and enablers identified in this study.

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Section: Discussionmentioning

confidence: 91%

Australian GPs’ perceptions of barriers and enablers to best practice palliative care: a qualitative study

et al. 2019

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“…Also in our study, more patients with cancer had been included than patients with COPD or CHF. This was also one of the conclusions of a review on palliative patient-GP communication [ 32 ].…”

Section: Discussionmentioning

confidence: 58%

Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial

et al. 2015

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BackgroundMost patients with advanced cancer, debilitating COPD or chronic heart failure (CHF) live at home. General practitioners (GPs) asked for guidance in how to recognize patients in need of palliative care in a timely way and to structure anticipatory care. For that reason, we developed a training for GPs in identifying patients in need of palliative care and in structuring anticipatory palliative care planning and studied its effect on out-of-hours contacts, contacts with their own GP, hospitalizations and place of death.MethodsWe performed a cluster randomised controlled trial. GPs in the intervention group were trained in identifying patients in need of palliative care and anticipatory care planning. Next, for each identified patient, they were offered a coaching session with a specialist in palliative care to fine-tune a structured care plan. The GPs in the control group did not receive training or coaching, and were asked to provide care as usual.After one year, characteristics of patients deceased of cancer, COPD or CHF in both study groups were compared with mixed effects models for out-of-hours contacts (primary outcome), contacts with their own GP, place of death and hospitalizations in the last months of their life (secondary outcomes). As a post-hoc analysis, of identified patients (of the intervention GPs) these figures were compared to all other deceased patients, who had not been identified as in need of palliative care.ResultsWe did not find any differences between the intervention and control group. Yet, only half of the trained GPs (28) identified patients (52), which was only 24 % of the deceased patients. Those identified patients had significantly more contacts with their own GP (B 4.5218; p <0.0006), were less often hospitalized (OR 0.485; p 0.0437) more often died at home (OR 2.126; p 0.0572) and less often died in the hospital (OR 0.380; p 0.0449).ConclusionsAlthough we did not find differences between the intervention and control group, we found in a post-hoc analysis that those patients that had been identified as in need of palliative care had more contacts with their GP, less hospitalizations, and more often died at home. We recommend future controlled studies that try to further increase identification of patients eligible for anticipatory palliative care.The Netherlands National Trial Register: NTR2815 date 07-04-2010

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“…We found no effect of the ACA training programme at either the GP or the patient level. 24 Although our findings indicate that the intervention is ineffective, there are other possible explanations that should be taken into consideration when interpreting the results. First, in comparison to medical specialists and oncology nurses, the GPs in our trial may have been so well trained in doctor–patient communication as part of their pre- and postgraduate education that additional training in specific elements of communication in palliative care may not have added much to their communication skills.…”

Section: Discussionmentioning

confidence: 69%

“…In an earlier article, we reported on the effects of this programme on GPs’ competence. 24 The quantitative analysis of videotaped consultations of GPs with simulated patients did not show an effect of the ACA training programme on the number of issues discussed or the quality of GPs’ communicative behaviour. Using simulated patients to establish an effect is not optimal because it focuses on a single consultation, while in daily practice, communication between doctors and patients evolves during several serial consultations.…”

Section: Introductionmentioning

confidence: 88%

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Effectiveness of the palliative care ‘Availability, Current issues and Anticipation’ (ACA) communication training programme for general practitioners on patient outcomes: A controlled trial

et al. 2014

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Background:Although communicating effectively with patients receiving palliative care can be difficult, it may contribute to maintaining or enhancing patients’ quality of life. Little is known about the effect of training general practitioners in palliative care–specific communication. We hypothesized that palliative care patients of general practitioners exposed to the ‘Availability, Current issues and Anticipation’ communication training programme would report better outcomes than patients of control general practitioners.Aim:To evaluate the effectiveness of the Availability, Current issues and Anticipation training programme for general practitioners on patient-reported outcomes.Design:In a controlled trial, general practitioners followed the Availability, Current issues and Anticipation programme or were part of the control group. Patients receiving palliative care of participating general practitioners completed the Palliative Care Outcome Scale, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative, the Rest & Peace Scale, the Patient Satisfaction Questionnaire–III and the Availability, Current issues and Anticipation Scale, at baseline and 12 months follow-up. We analysed differences between groups using linear mixed models. Trial registration: ISRCTN56722368.Setting/participants:General practitioners who attended a 2-year Palliative Care Training Course in the Netherlands.Results:Questionnaire data were available for 145 patients (89 in intervention and 56 in control group). We found no significant differences over time between the intervention and control groups in any of the five outcome measures. Ceiling effects were observed for the Rest & Peace Scale, Patient Satisfaction Questionnaire–III and Availability, Current issues and Anticipation Scale.Conclusion:General practitioner participation in the Availability, Current issues and Anticipation training programme did not have a measurable effect on any of the outcomes investigated. Patients reported high levels of satisfaction with general practitioner care, regardless of group assignment. Future research might focus on general practitioners without special interest in palliative care.

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Effectiveness of the ACA (Availability, Current issues and Anticipation) training programme on GP-patient communication in palliative care; a controlled trial

Cited by 12 publications

References 21 publications

Australian GPs’ perceptions of barriers and enablers to best practice palliative care: a qualitative study

Australian GPs’ perceptions of barriers and enablers to best practice palliative care: a qualitative study

Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial

Effectiveness of the palliative care ‘Availability, Current issues and Anticipation’ (ACA) communication training programme for general practitioners on patient outcomes: A controlled trial

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