Proactive advance care planning conversations in general practice: a quality improvement project.

Area of Science:

• Geriatrics
• Palliative Care
• Primary Care Medicine

Background:

• Advance care planning (ACP) is crucial for future medical treatment decisions, yet many patients, especially those with progressive non-malignant conditions, miss these conversations.
• The Royal College of General Practitioners and Marie Curie Daffodil Standards (2020) offer a framework for enhancing end-of-life care in primary care, emphasizing proactive patient identification.

Purpose of the Study:

• To assess the adoption and acceptability of personalized ACP conversations using a 'What matters to you' (WMTY) framework in general practice.
• To ensure equitable inclusion of diverse diagnostic and demographic groups in ACP discussions.
• To evaluate the documentation of future care guidance following these conversations.

Main Methods:

• A quality improvement project offered ACP conversations to patients without prior planning, potentially in their last year of life.
• Patient feedback was collected via a survey to assess acceptability.
• Documentation of future care was recorded using the Recommended Summary for Emergency Care and Treatment (ReSPECT) plan.

Main Results:

• 81% of eligible patients accepted an ACP conversation.
• Future care guidance was documented in most cases using the ReSPECT plan.
• High levels of clinician and patient satisfaction were reported.

Conclusions:

• ACP discussions utilizing the 'WMTY' format are highly acceptable and effective in primary care settings.
• Personalized conversations focusing on quality of life and death priorities can positively reframe ACP, increasing initiation.
• Integrating ACP into routine general practice requires process adjustments and clinician education, supported by initiatives like the Daffodil Standards.