Clinicians' experiences implementing an advance care planning pathway in two Canadian provinces: a qualitative study

Area of Science:

• Healthcare Delivery
• Patient-Centered Care
• Clinical Implementation Science

Background:

• Advance care planning (ACP) is crucial for patients to communicate future medical care preferences.
• Despite patient interest, ACP discussions are infrequent due to various barriers.
• A novel ACP care pathway was implemented in Canadian general outpatient settings to address these barriers.

Purpose of the Study:

• To understand clinician experiences implementing a new advance care planning pathway.
• To identify barriers and facilitators to pathway implementation in primary care and general internal medicine.
• To assess the feasibility and impact of the ACP pathway on clinician practice and patient care.

Main Methods:

• A structured ACP care pathway, using the Serious Illness Conversation Guide, was implemented in four outpatient clinics across two Canadian provinces.
• Participating clinicians included physicians and allied health professionals.
• Qualitative data were collected through interviews and focus groups with twelve physicians and one social worker, followed by inductive coding.

Main Results:

• Clinicians found the ACP pathway feasible to implement and integrate into existing workflows.
• The pathway's structure and tools positively impacted clinician confidence and patient interactions.
• Facilitators included teamwork and patient preparation, while workflow compatibility was a key consideration.

Conclusions:

• The implemented ACP care pathway is a feasible and valuable tool for general outpatient settings.
• Clinicians reported positive impacts on their confidence and patient communication.
• The pathway's structure and tools were well-received, suggesting potential for broader adoption and sustainability.