Advance care planning (ACP) in patients with a chronic life-limiting illness in general practice: a RCT on the effectiveness of ACP on the quality of communication and concordance between preferred and delivered end-of-life care

Many patients with a chronic life-limiting illness receive inappropriate or futile care at the end of life (EOL), which mostly results from a mismatch between patients’ preferences and the norms of current practice. An important prerequisite for care that adequately addresses patients’ preferences is timely and efficient communication. Advance Care Planning (ACP) is a formalized process of communication between patients, their family carers and professional caregivers about patients’ care preferences at the EOL. ACP has shown to enhance care that is consistent with patients’ goals, and improve patients’ quality of life and the quality of care delivered at the EOL. Most patients with serious chronic illnesses are treated and cared for over a long period of time in primary care. GPs are in an ideal position to initiate ACP, given their often longstanding and trusting relationship with patients. However, evidence on the effects of ACP in general practice is scarce. We will perform the first cluster-randomized controlled trial on the effects of ACP in general practice for patients with a
chronic life-limiting illness. As such, we will be able to provide the highest level of evidence for the effectiveness of our intervention. We will also conduct a thorough process evaluation to evaluate how this complex intervention was delivered, which will enhance our understanding on how this ACP intervention could move from research to practice.