Advance care planning in Dutch primary care: a pre/post-implementation study.

Area of Science:

• Gerontology
• Primary Care Medicine
• Health Services Research

Background:

• Advance care planning (ACP) offers benefits, yet conversations remain infrequent in primary care settings.
• Older adults and general practitioners (GPs) express positive attitudes towards ACP.
• Barriers to routine ACP implementation persist in community-based GP practices.

Purpose of the Study:

• To integrate advance care planning (ACP) into routine general practice care.
• To increase the frequency of ACP discussions and the creation of advance directives.
• To identify characteristics distinguishing older individuals who have engaged in ACP conversations from those who have not.

Main Methods:

• A mixed-methods approach combining pre- and post-implementation questionnaire data from community-dwelling individuals aged 75 and older.
• A prospective study analyzing data from healthcare professionals on initiated ACP conversations.
• Utilized community-dwelling older adults' questionnaire data and healthcare professionals' prospective data.

Main Results:

• Post-implementation, a significant rise in ACP conversations concerning hospitalizations, intensive care, and treatment preferences was observed.
• The rate of advance directive creation also increased following the ACP implementation.
• Individuals with an ACP conversation were older, had a history of cerebrovascular accidents, and had previously discussed preferences with their GP.

Conclusions:

• The study demonstrated modest but positive outcomes in ACP conversations and advance directive generation.
• Advance care planning (ACP) was successfully integrated into routine general practice.
• While GP-led patient selection for ACP can be efficient, it poses a risk of excluding vulnerable patient groups, such as those with multimorbidity or lower health literacy.