Attitudes to earlier advance care planning: a qualitative interview study in general practice

Advance care planning (ACP) research has often focused on those experiencing deteriorating health. There is limited research regarding attitudes to early ACP among people living with long-term conditions without advanced illness or severe frailty.

To explore how people living with a non-cancer long-term condition understand ACP; and their preferences for how, if at all, these discussions should be undertaken, including within annual health reviews.

Qualitative interviews undertaken with participants from general practices in village, market town, coastal town, and city settings within England, UK.

The interviews were semi-structured and in depth. The inclusion criteria were: >18 years old; registered at a participating practice; living with cardiovascular disease, diabetes mellitus, kidney disease, or chronic obstructive pulmonary disease. Thematic analysis used a critical realist approach. Participants contributed to a member checking process. This study had NHS ethics approval (23/PR/0078).

In total, 21 participants were recruited who were aged 61-91 years, eight were men, and 17 participants were living with multimorbidity. Participants discussed three forms of ACP: proactive planning, preparing for change, and discussing the end of life. Participants described early ACP as less distressing. Participants perceived ACP as an ongoing process, with early consultations encouraging discussion of existing preferences and preparing people for future decision making. Participants discussed how ACP could facilitate proactive and person-centred health care. Participants described the importance of normalising ACP.

This study suggests that ACP may be well received and could be discussed earlier with adults living with long-term conditions, before onset of advanced illness or severe frailty.