Advance care planning in general practice and beyond: A cluster-randomized controlled trial of the ACP-GP intervention

People with a chronic, life-limiting illness may be confronted with complex choices about their medical care. Their illness may also lead to a loss of decisional capacity. Advance care planning (ACP) is a process of communication between the patient, healthcare professionals, and loved ones, about the patient’s values, wishes, and goals for care. By discussing these topics in a timely manner and revisiting them over time, all involved parties can be better prepared for medical decision-making in the moment and in the future. Outpatient settings, such as general practice and primary care, have been proposed as ideal for initiating and facilitating ACP. However, deficits remain in ACP in this setting, including in Belgian general practice.

To mitigate barriers and maximize facilitators to ACP in Belgian general practice, a complex intervention, the ACP-GP intervention, has been developed. In the first part of this dissertation, the intervention is implemented and evaluated through a cluster-randomized controlled trial with a parallel process evaluation. The second part of this dissertation complements the first by describing insights into the implementation of ACP interventions internationally. This is accomplished through a scoping review of the literature and a qualitative study of clinicians’ experiences implementing an ACP pathway in two Canadian provinces.

The findings from this dissertation lead to several recommendations for practice, policy, and future research directions.