Implementation of a new pictorial tool designed to facilitate communication around advance care planning: a...

To evaluate the feasibility of using a new pictorial tool (the DPAC) to structure conversations about advance care planning (ACP) with frail older adults.

This was a mixed-methods study involving older adults with advanced or chronic disease who had been admitted to the convalescence or long-stay unit of an intermediate care hospital in Barcelona, or to a geriatric care facility in the same city. One hundred patients were interviewed about their future care preferences using the DPAC, following which we gathered quantitative data relating to four feasibility indicators: acceptability (patients' view), usefulness (patients' view), applicability (time required for interview) and clinical utility (physician's view). Twenty of these patients were subsequently interviewed to explore their experience of the DPAC interview. Interview transcripts were then analysed using an inductive thematic approach.

The quantitative results supported the feasibility of using the DPAC for ACP in clinical practice. All patients (100%) found it acceptable and useful, and 86% of interviews were completed within the established time limit of 45 min. In 98% of interviews, the physician conducting the ACP conversation rated the tool as useful. Qualitative analysis revealed four main themes that described patients' experience of the DPAC interview: (1) Feeling heard and accompanied, (2) Facilitating the expression of emotions and personal concerns, (3) Appraisal of the structured pictorial format, and (4) Clarification and decision making.

The DPAC appears to be a promising pictorial tool for structuring and engaging in meaningful conversations about future care preferences with frail older adults.