Complex advance care planning intervention in general practice (ACP-GP): a cluster-randomised controlled trial

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Abstract

Background Advance care planning (ACP) is an iterative communication process about patients’ preferences for future care. In general practice, there are barriers to ACP at patient, GP, and healthcare-system levels. A complex intervention may be necessary to reduce barriers.

Aim To evaluate the effects of a complex ACP intervention for patients with chronic, life-limiting illness in general practice (ACP-GP).

Design and setting A cluster-randomised controlled trial was undertaken in Belgian general practice.

Method ACP-GP included a patient workbook, GP training, ACP conversations, and a documentation template. The control group received usual care. Outcomes were the 15-item ACP Engagement Survey for patients and the ACP Self-Efficacy scale for GPs. Linear mixed models evaluated differences at 3 months (T1, effectiveness evaluation) and 6 months (T2) post-baseline. Analysis was intention-to-treat.

Results In total, 35 GPs and 95 patients were randomised. Patient ACP engagement did not differ between the intervention and control group at T1 (baseline-adjusted mean difference = 0.34; 95% confidence interval [CI] = −0.02 to 0.69; P = 0.062) or T2 (baseline-adjusted mean difference = 0.20; 95% CI = −0.17 to 0.57; P = 0.28). For GP ACP self-efficacy, there were no significant differences between groups at T1 (baseline-adjusted mean difference = 0.16; 95% CI = −0.04 to 0.35; P = 0.11) or at T2 (baseline-adjusted mean difference = 0.11; 95% CI = −0.09 to 0.31; P = 0.27).

Conclusion ACP-GP did not improve patient engagement and GP self-efficacy more than usual care. Both groups showed patterns of increase from baseline. Trial procedures and the COVID-19 pandemic may have increased awareness about ACP.
Original languageEnglish
Pages (from-to)78-87
Number of pages10
JournalBritish Journal of General Practice
Volume74
Issue number739
DOIs
Publication statusPublished - 1 Feb 2024

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