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Understanding of advance care planning in primary care: a gap analysis
Josephine Chow1, Ann Harley2, Danielle Ni Chroinin3
1South Western Sydney Local Health District, Sydney, NSW, Australia; and Clinical Stream Office, Don Everett Building, Locked Bag 7103, BC 1871, Liverpool, NSW 2170, Australia; and University of Sydney, Sydney, NSW, Australia; and University of New South Wales, Sydney, NSW, Australia; and Western Sydney University, Sydney, NSW, Australia.
Background:
Although primary care is a well suited context for conducting advance care planning (ACP), there are many barriers to initiating discussions regarding future health preference and end-of-life conversations.
Methods:
This qualitative study conducted 30 detailed individual interviews with senior administrators, medical and nurse practitioners of a local health district, NSW Ambulance, e-Health NSW, general practitioners and practice nurses to find out about barriers to ACP in South Western Sydney.
Results:
Thematic analysis was conducted on the interviews. Six major themes were identified: Prevalence; Empowerment of roles and responsibilities; Lack of training/knowledge/confidence; Fragmentation of care; Patient/family readiness; and Prognostication. Half of the participants were willing to use a prognostic tool to identify when a patient was likely to be at the end of their life and provide a prompt to initiate ACP.
Conclusion:
In addition to addressing training and acknowledging resource constraints, these findings suggest that if a prognostic tool was validated and practical in a primary care setting, it may provide valuable assistance to encourage everyone in society to begin discussing this issue and completing ACP.
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