Abstract
Background
Advance care planning (ACP) is a process of communication between the patient, his/her family and health-care providers regarding the patient's future care for the event of the patient's incapacity to make decisions. However, ACP discussions rarely occur. In Belgium, GPs play a pivotal role in the (end-of-life) care of patients, placing them in an ideal position to initiate ACP. This study aims (1) to develop an intervention aimed at improving ACP in primary care and (2) to evaluate this intervention in a pilot study. The broad definition of ACP requires an intervention that is targeted at both patients and their GPs, making this a complex intervention.
Method
Firstly, a systematic review about the effectiveness of existing interventions aimed at starting up ACP in primary care will be conducted. A second systematic review will examine the barriers and facilitators for GPs to implement ACP in daily practice. The results of the reviews will be discussed in focus groups with Flemish GPs in order to integrate their perceptions in the development of the intervention. In a next phase, the intervention will be developed. The intervention aimed at patients will be presented to patients with advanced cancer during in-depth interviews to adapt the intervention to their needs. Finally, the intervention will be evaluated in a pilot study. GPs and patients will be randomized to an intervention group (respectively the GP-intervention and the patient-intervention) and a control group (usual care). Measurements by GP and patient questionnaires will take place at t0 before the intervention, at t1 two months after the intervention and t2 twelve months later.
Discussion
This study is an intensive process aimed at distilling the best intervention to promote ACP in the GP-setting from all existing evidence and research. This study takes not only the perceptions of GPs in account, but also includes the experiences and needs of patients, which is a major ethical challenge.
Funding source: IWT SBO
Advance care planning (ACP) is a process of communication between the patient, his/her family and health-care providers regarding the patient's future care for the event of the patient's incapacity to make decisions. However, ACP discussions rarely occur. In Belgium, GPs play a pivotal role in the (end-of-life) care of patients, placing them in an ideal position to initiate ACP. This study aims (1) to develop an intervention aimed at improving ACP in primary care and (2) to evaluate this intervention in a pilot study. The broad definition of ACP requires an intervention that is targeted at both patients and their GPs, making this a complex intervention.
Method
Firstly, a systematic review about the effectiveness of existing interventions aimed at starting up ACP in primary care will be conducted. A second systematic review will examine the barriers and facilitators for GPs to implement ACP in daily practice. The results of the reviews will be discussed in focus groups with Flemish GPs in order to integrate their perceptions in the development of the intervention. In a next phase, the intervention will be developed. The intervention aimed at patients will be presented to patients with advanced cancer during in-depth interviews to adapt the intervention to their needs. Finally, the intervention will be evaluated in a pilot study. GPs and patients will be randomized to an intervention group (respectively the GP-intervention and the patient-intervention) and a control group (usual care). Measurements by GP and patient questionnaires will take place at t0 before the intervention, at t1 two months after the intervention and t2 twelve months later.
Discussion
This study is an intensive process aimed at distilling the best intervention to promote ACP in the GP-setting from all existing evidence and research. This study takes not only the perceptions of GPs in account, but also includes the experiences and needs of patients, which is a major ethical challenge.
Funding source: IWT SBO
| Original language | English |
|---|---|
| Pages (from-to) | 472-472 |
| Number of pages | 1 |
| Journal | Palliative Medicine |
| Volume | 26 |
| Publication status | Published - 4 Jun 2012 |
Keywords
- Advance care planning
- General practitioner
- complex trial