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

Area of Science:

• Gerontology
• Public Health
• Healthcare Management

Background:

• Advance care planning (ACP) research predominantly focuses on individuals with deteriorating health.
• Limited research exists on attitudes towards early ACP among people with long-term conditions (LTCs) without advanced illness or severe frailty.

Purpose of the Study:

• To explore understanding of ACP among individuals with non-cancer LTCs.
• To identify preferences for how ACP discussions should be conducted, including within annual health reviews.

Main Methods:

• Qualitative, semi-structured, in-depth interviews with 21 participants (aged 61-91) living with cardiovascular disease, diabetes mellitus, kidney disease, or chronic obstructive pulmonary disease.
• Thematic analysis using a critical realist approach was employed.
• Participants were recruited from diverse general practice settings (village, market-town, coastal town, city).

Main Results:

• Participants identified three forms of ACP: proactive planning, preparing for change, and end-of-life discussions.
• Early ACP was perceived as less distressing and an ongoing process, facilitating discussion of preferences and future decision-making.
• ACP was seen as a way to promote proactive, person-centred healthcare and the importance of normalizing these discussions was highlighted.

Conclusions:

• Advance care planning may be well-received when initiated earlier in adults with long-term conditions.
• Discussions can commence before the onset of advanced illness or severe frailty, promoting proactive and person-centred care.