Evaluation of a process to implement advance care planning conversations in primary care: uptake and patient experience

Abstract

ABSTRACTObjectiveAdvance care planning (ACP) can support patients in achieving current and future medical care that aligns with their values and goals. In primary care, a lack of standardized processes hinders implementation of ACP conversations. This study reports a quality improvement process to identify and engage patients and clinicians in ACP.MethodsPrimary care clinicians received training in conversations based on the Serious Illness Conversation Guide and tools to support ACP. In December 2019, patients 65 years of age and older with chronic obstructive pulmonary disease were systematically identified, mailed ACP resources and telephoned by the clinic to invite them to an ACP appointment. We tracked the attendance of the patients and evaluated patient experience using a survey.ResultsOf the 91 patients telephoned, 50 were reached, and 27 attended the appointment. Further efforts were suspended in March 2020 due to the COVID-19 pandemic. Thirteen patients completed the survey. There were statistically significant increases in the patient’s perception of being heard and understood by their physician, feeling hopeful about quality of life and feeling peaceful.ConclusionThis study provides evidence that with training, tools and processes, patients and primary care clinicians can be effectively engaged in ACP conversations.KEY MESSAGESWhat was already known?Training resources exist for help clinicians enhance their advance care planning communication skillsBesides a need for skills, other practical challenges exist in implementing advance care planning in family practiceWhat are the new findings?Structured patient identification and preparation can facilitate advance care planning conversations in family practicePatients reported positive experiences of the conversationsWhat is their significance?Clinical: It is important to move beyond clinician training alone to implement processes in family practice to trigger advance care planning conversationsResearch: Further research to identify effective scalable approaches to triggering and implementing advance care planning conversations in family practice would be beneficial