Sowing seeds: supporting initiation and engagement of advance care planning in general practice

Abstract

This dissertation focuses on supporting the initiation and implementation of advance care planning (ACP) in general practice for older people and patients with chronic-progressive diseases. ACP enables patients to express and communicate their values, goals, and preferences for future medical care. Although general practitioners (GPs) are ideally positioned to conduct these conversations, ACP is still insufficiently applied in daily practice. This thesis addresses two main challenges: limited ACP training in GP education and difficulty identifying suitable moments to start ACP.

It explores an educational tool to support GP trainees in learning how to conduct ACP conversations. Using a phenomenological interview study, GP residents’ experiences with virtual simulation were examined.

Further, it focuses on using routine primary care data to support timely ACP initiation. Using health record (survey) studies and a nested case-control study, the optimal time to initiate ACP were determined and this and its clinical triggers for it where identified in routine primary care data. Findings could lay the foundation for developing an automated identification tool within electronic health records to help GPs recognize patients who may benefit from ACP. The final discussion reflects on the findings of the chapters, current views on ACP, societal taboos, patient perspectives, several educational considerations for improving ACP training in GP residency, and offers recommendations for clinical practice and future research.