Experiences with implementing advance care planning (ACP-GP) in Belgian general practice in the context of a cluster...

Area of Science:

• Gerontology
• Primary Care Medicine
• Health Services Research

Background:

• General practice is recommended for advance care planning (ACP) initiation, yet uptake remains low.
• The ACP-GP intervention aimed to boost patient engagement and GP self-efficacy in ACP for chronic illnesses.
• A cluster-randomized controlled trial found the intervention was not superior to control, necessitating a process evaluation.

Purpose of the Study:

• To understand the implementation process of the complex ACP-GP intervention.
• To identify factors influencing the trial outcomes of ACP engagement and GP self-efficacy.
• To inform future strategies for facilitating ACP in primary care settings.

Main Methods:

• A mixed-methods process evaluation using the RE-AIM framework.
• Data collected via recruitment monitoring, questionnaires, and semi-structured interviews with patients and GPs.
• Quantitative data analyzed descriptively; qualitative data analyzed inductively and deductively.

Main Results:

• Low GP reach but moderate to good adoption of most intervention components.
• Patients reported reassurance from ACP conversations; GPs valued positive framing.
• High participant satisfaction with implementation, but moderate intention for future maintenance.
• GPs questioned sustainable methods for integrating ACP conversations.

Conclusions:

• The ACP-GP intervention is feasible and can be successfully implemented in general practice.
• Challenges in the implementation process and suboptimal sustainability were identified.
• Findings offer guidance for future research and recommendations to improve ACP facilitation and implementation.