Advance Care Planning in Primary Care: A Step toward Normalizing the Conversation

Area of Science:

• Healthcare Quality Improvement
• Primary Care Medicine
• Health Communication

Background:

• Advance care planning (ACP) conversations remain infrequent in healthcare despite available tools.
• Barriers to ACP exist, hindering routine integration into patient care.
• A novel approach is needed to facilitate effective ACP discussions.

Purpose of the Study:

• To develop and implement a user-centered intervention to increase the frequency and quality of ACP conversations in primary care.
• To integrate best practices for ACP, emphasizing patient values over treatment decisions.
• To address identified barriers and normalize ACP within the primary care setting.

Main Methods:

• A quality improvement project applying complex adaptive systems theory.
• Development of a standardized electronic form (e-form) with prompts, co-designed with family physicians.
• Focus on user needs and patient values to guide intervention design.

Main Results:

• The developed e-form successfully integrated ACP best practices by shifting focus to patient values.
• The intervention met the needs of both healthcare providers (users) and patients.
• The approach addressed existing barriers, facilitating the normalization of ACP conversations.

Conclusions:

• A user-emergent, standardized e-form intervention can effectively promote advance care planning in primary care.
• Shifting ACP conversations to patient values is a key component for successful implementation.
• This intervention holds potential utility for various primary care practices seeking to normalize ACP.