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The patient's relationship with the General Practitioner before and after Advance Care Planning:
Annicka G M van der Plas1,2, Julia E A P Schellekens3,4, Jolien J Glaudemans5
1Department of Public and Occupational Health, Amsterdam UMC, Location VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. eol@amsterdamumc.nl.
BMC Geriatrics
|July 5, 2022
Summary
Advance Care Planning (ACP) conversations between doctors and older patients did not require pre-existing trust. However, engaging in ACP discussions positively impacted the doctor-patient relationship, maintaining or increasing patient trust.
Area of Science:
- Gerontology
- Primary Care Medicine
- Health Communication
Background:
- General Practitioners (GPs) are pivotal in Dutch elder care and well-positioned for Advance Care Planning (ACP) discussions.
- Doctor-patient relationships significantly influence the initiation and outcomes of ACP conversations.
Purpose of the Study:
- To investigate the association between having an ACP conversation and patients' perceptions of their GP's knowledge of them and their trust in the GP.
- To explore the reciprocal relationship between ACP conversations and the doctor-patient dynamic.
Main Methods:
- A pre- and post-implementation design evaluated ACP in primary care.
- Questionnaires were administered to patients aged 75+ before and 14 months after ACP implementation across 10 GP practices and 2 care homes.
- Multivariable and generalized ordered logistic regression analyses modeled the relationships between ACP conversations and the patient-GP relationship.
Main Results:
- No association was found between pre-existing GP knowledge/trust and having an ACP conversation.
- Patients who engaged in ACP conversations were more likely to maintain or increase trust in their GP (trust for good care OR 2.93; trust for following wishes OR 2.59).
- A reduction in patient trust was less probable following ACP conversations.
Conclusions:
- While trust may not be a prerequisite for initiating ACP, these conversations demonstrably benefit the doctor-patient relationship.
- ACP implementation in primary care can positively influence patient trust and the overall therapeutic alliance.
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