Advance care planning engagement in patients with chronic, life-limiting illness: baseline findings from a cluster-randomised controlled trial in primary care

Abstract

Background: Advance care planning (ACP) has been characterized as a complex process of communication and decision-making. For ACP behavior change, underlying processes such as self-efficacy and readiness are needed. However, studies of which patient characteristics are associated with ACP have mainly focused on whether ACP actions are completed, leaving behavior change processes unexplored. Aim: To assess whether patients’ characteristics, and patient-perceived GP ACP communication, are associated with patient’s ACP engagement. Design and Setting: Baseline data from the ACP-GP cluster-randomized controlled trial in patients with chronic, life-limiting illness (n=95). Method: Patients completed questionnaires for demographic and clinical characteristics, and for perception of the GP’s ACP information provision and listening. Engagement was measured using the 15-item ACP Engagement Survey, with self-efficacy and readiness subscales. Linear mixed models tested associations with engagement. Results: Demographic and clinical characteristics were not associated with engagement; nor ratings of how much ACP information they received from the GP; the extent to which the GP listened to what was important for the patient to live well, or listened to what was important to the patient regarding future care. Higher overall ACP engagement (p=.002) and self-efficacy (p<.001) were observed in patients who gave a high rating for the extent to which their GP listened to their worries regarding future health. Conclusion: Our study suggests that GPs’ providing information about ACP alone is not associated with patients’ ACP engagement; an important element is to also listen to patients’ worries regarding their future health.

Complex advance care planning intervention in general practice (ACP-GP): a cluster-randomised controlled trial

“… 27 Baseline data from this study have been analysed. 24 To report this cluster-RCT, the Consolidated Standards of Reporting Trials (CONSORT) statement extension for cluster-randomised trials was used. 28 …”

“… 23 The authors of the present study have previously also found that patients have greater ACP engagement overall, and greater ACP self-efficacy, when they rate highly the extent to which their GP listens to their worries about future health, emphasising the importance of communication. 24 To address identified barriers and facilitate the initiation of ACP, a complex intervention for general practice (ACP-GP intervention) was developed and pilot-tested following the Medical Research Council framework. 23 , 25 , 26 The present study aimed to evaluate the effects of the ACP-GP intervention on ACP engagement of patients with chronic, life-limiting illnesses and on GPs’ ACP self-efficacy.…”

Navigating the complex path of end-of-life care: Exploring the role of advance care planning

“…However, since then, ACP has evolved into a broader process of communication and decision-making. This extended process includes engaging in conversations about values and care preferences with family and healthcare providers, reflecting on care wishes and revisiting these decisions over time [2]. This expansion to include discussions of values is a response to the difficulty of predicting specific interventions for the final stages of life, given the uncertainty surrounding patients' health trajectories.…”