Complex advance care planning intervention in general practice (ACP-GP): a cluster-randomised controlled trial.

Area of Science:

• Gerontology
• Primary Care Medicine
• Health Services Research

Background:

• Advance care planning (ACP) is crucial for patients with chronic, life-limiting illnesses to communicate future care preferences.
• General practice faces significant barriers to implementing ACP effectively at patient, GP, and system levels.
• Complex interventions may be necessary to overcome these barriers and facilitate ACP.

Purpose of the Study:

• To evaluate the effectiveness of a complex ACP intervention (ACP-GP) delivered in a general practice setting.
• To assess the impact of the ACP-GP intervention on patient engagement in advance care planning.
• To determine the effect of the ACP-GP intervention on general practitioners' (GPs) self-efficacy in conducting ACP.

Main Methods:

• A cluster-randomised controlled trial was conducted in Belgian general practice.
• The intervention (ACP-GP) comprised a patient workbook, GP training, dedicated ACP conversations, and a documentation template.
• Outcomes included patient ACP engagement (ACP Engagement Survey) and GP self-efficacy (ACP Self-Efficacy scale), assessed at 3 and 6 months post-baseline using linear mixed models.

Main Results:

• No statistically significant differences in patient ACP engagement were found between the intervention and control groups at 3 or 6 months.
• Similarly, no significant differences in GP ACP self-efficacy were observed between the groups at either time point.
• Both intervention and control groups demonstrated a general increase in outcomes from baseline.

Conclusions:

• The ACP-GP intervention did not demonstrate superior effectiveness over usual care in enhancing patient engagement or GP self-efficacy.
• Factors such as trial procedures and the COVID-19 pandemic may have inadvertently increased awareness and engagement with ACP.
• Further research may be needed to refine complex interventions for effective ACP implementation in primary care settings.