Information meetings on end-of-life care for older people by the general practitioner to stimulate advance care planning: a pre-post evaluation study

Abstract

Background To increase knowledge about options people have concerning end-of-life-care issues, General Practitioners (GPs) can organise meetings to inform their older patients. We evaluated these meetings, using the following research questions: How did the attendees experience the information meeting? Was there a rise in Advance Care Planning (ACP) behaviour after the information meeting? Was there a change in trust people have that physicians will provide good care at the end of life and that they will follow their end-of-life wishes after the information meetings? Methods Four GPs invited all patients of 75 years and older registered in their GP practices to the meeting via a written letter. Four meetings of 2 h took place in 2016. Meetings started with a presentation on end-of-life topics and ACP by the GP followed by time for questions. A pre-post evaluation study was done using written questionnaires distributed and filled in at the start of the meeting (T0) at the end of the meeting (T1) and 6 months after the meeting (T2). Results In total 225 older people attended a meeting of which 154 (68%) filled in the questionnaire at T0 and 145 (64%) filled in the questionnaire at T1. After six months, 90 of the 121 people who approved of being sent another questionnaire at T2, returned it (40%). The average age of the respondents was 80 years (T0). The meetings were evaluated positively by the attendees (T1). ACP issues (appointing a proxy, resuscitation, hospitalisation, euthanasia, treatment preferences under certain circumstances, preferred place of care and nursing home admittance) were discussed with a physician, a relative or both more often in the 6 months after having attended the meeting (T2), compared to before (T0). Compared to before the meeting (T0), trust in the GP providing good end-of-life care and following end-of-life wishes was higher immediately after the meeting (T1), but not after 6 months (T2). Conclusion Information meetings on end-of-life care by GPs have a positive influence on the occurrence of ACP, both with the physician and others. Although, this method especially reaches the older people that are already interested in the subject, this seems a relatively easy way to stimulate ACP.

End-of-life treatment preference discussions between older people and their physician before and during the COVID-19 pandemic: cross sectional and longitudinal analyses from the Longitudinal Aging Study Amsterdam

“…In our study, most older adults had thought about ACP topics during COVID-19, but had not discussed them with a physician. Two other studies among Dutch older adults aged 75 years and above (before COVID-19), using different Dutch data, found similar prevalence regarding ACP [ 16 , 17 ]. These two studies also found that most older adults think about ACP topics, however that discussing ACP with a physician is still not that common [ 16 , 17 ].…”

“…Two other studies among Dutch older adults aged 75 years and above (before COVID-19), using different Dutch data, found similar prevalence regarding ACP [ 16 , 17 ]. These two studies also found that most older adults think about ACP topics, however that discussing ACP with a physician is still not that common [ 16 , 17 ]. However, also discussing your preferences and wishes with a physician is found to be important for receiving end-of-life care in accordance with preferences and preventing unnecessary and undesirable hospital admissions [ 18 ].…”

“…Information meetings about ACP given by the general practitioner might be a good way to do this. We found earlier that such meetings stimulate ACP discussion with physicians, but even more with others, like family or friends [ 17 ].…”

End-of-life health literacy, knowledge and behaviours towards advance care planning among older adults: cross-sectional evidence from Switzerland

“…For instance, in the Netherlands, research showed that inviting older adults to information sessions about EOL healthcare led by general practitioners can positively impact individuals' engagement in ACP. 59 The authors further explained that although this approach mainly resonates with older individuals already curious about the topic, it appears to be a straightforward way to encourage ACP. 59 It is also crucial to enlighten healthcare providers about the significance of assessing the health competency level of patients concerning EOL healthcare.…”

“…59 The authors further explained that although this approach mainly resonates with older individuals already curious about the topic, it appears to be a straightforward way to encourage ACP. 59 It is also crucial to enlighten healthcare providers about the significance of assessing the health competency level of patients concerning EOL healthcare. This would enable them to tailor their communication, fostering better understanding between patients and healthcare providers.…”