How do Dutch primary care providers overcome barriers to advance care planning with older people? A qualitative study

Glaudemans, Jolien J; Jong, Anja E de; Philipsen, B.D.; Wind, Jan; Willems, Dick L.

doi:10.1093/fampra/cmy055

Cited by 20 publications

(23 citation statements)

References 32 publications

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“…Adaptations to initiating the conversation included addressing emotion by strategies to elicit patient values rather than specific treatment choices (Ahluwalia et al, 2015). Negative social influences were addressed by preparing patients through brochures or public awareness campaigns (Glaudemans, de Jong, Onwuteaka Philipsen, Wind, & Willems, 2019;Howard et al, 2018;Wissow et al, 2004) and using patient video decision aids (Volandes et al, 2016). Positive social influences were created by promoting collaboration between primary care providers and specialists (Chandar et al, 2017) and using practice champions (Wissow et al, 2004).…”

Section: Adaptationsmentioning

confidence: 99%

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care

Nelson-Brantley

Buller

Befort

et al. 2019

J of Nursing Scholarship

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Section: Adaptationsmentioning

confidence: 99%

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care

Nelson-Brantley

Buller

Befort

et al. 2019

J of Nursing Scholarship

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“… 5–7 ACP can, however, be difficult, time-consuming and require adequate financing, transfer of information and training, and the purpose, form and efficacy of ACP in daily practice are the subject of discussion. 8 9 …”

Section: Introductionmentioning

confidence: 99%

Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

et al. 2018

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ObjectivesAdvance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice.Design, setting and participantsA qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews.ResultsApproaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive geriatric assessments and periodic assessments. Meetings were aimed at making agreements in anticipation of future care, at providing information and encouraging older people to take further steps in ACP. With ad hoc approaches, respondents discussed only one or two topics related to the near future. Ad hoc ACP was mainly done with deteriorating patients or when patients or family initiated ACP. Systematic and ad hoc approaches were used simultaneously or sequentially and were both used for initiating and following up on ACP. Due to a lack of time and knowledge of other occasions and topics than the ones respondents used, respondents seemed to underuse many occasions and topics.ConclusionsAwareness of appropriate systematic and ad hoc approaches for ACP, and the focus on providing information and encouraging older people to take further steps in ACP reported in this study can support GPs and improve older patients’ access to ACP.

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“…A qualitative approach using in-depth face-to-face interviews was most appropriate for our exploratory aim, taking into account that discussing ACP experiences may be a sensitive and personal matter, and knowledge on older people’s and families’ experiences is limited. We developed an interview guide (see Table 1 ) based on a literature ( 6 , 15 , 19 ). To get a better understanding of what ACP with older people in general can and should consist of, and because the term ACP is not commonly used in the Netherlands, we deliberately explained ACP in a broad and inclusive way.…”

Section: Methodsmentioning

confidence: 99%

Preventing unwanted situations and gaining trust: a qualitative study of older people and families’ experiences with advance care planning in the daily practice of primary care

2019

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Background Using advance care planning (ACP) to anticipate future decisions can increase compliance with people’s end-of-life wishes, decrease inappropriate life-sustaining treatment and reduce stress, anxiety and depression. Despite this, only a minority of older people engage in ACP, partly because care professionals lack knowledge of approaches towards ACP with older people and their families. Objective To explore older people’s and their families’ experiences with ACP in primary care. Methods We conducted qualitative, semi-structured, face-to-face interviews with 22 older people (aged >70 years, v/m: 11/11), with experience in ACP, and eight of their family members (aged 40–79 years, f/m: 7/1). Transcripts were inductively analysed using a grounded theory approach. Results We distinguished three main themes. (i) Openness and trust: Respondents were more open to ACP if they wanted to prevent specific future situations and less open if they lacked trust or had negative thoughts regarding general practitioners’ (GPs’) time for and interest in ACP. Engaging in ACP appeared to increase trust. (ii) Timing and topics: ACP was not initiated too early. Quality of ACP seemed to improve if respondents’ views on their current life and future, a few specific future care scenarios and expectations and responsibilities regarding ACP were discussed. (iii) Roles of family: Quality of ACP appeared to improve if family was involved in ACP. Conclusions Quality and accessibility of ACP may improve if GPs and nurses involve family, explain GPs’ interest in ACP and discuss future situations older people may want to prevent, and views on their current life and future.

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How do Dutch primary care providers overcome barriers to advance care planning with older people? A qualitative study

Abstract: Primary care professionals can overcome barriers to ACP with older patients by practicing, reflecting on experiences and pursuing continuing education, by preparing patients and involving family and by investing in support to approach ACP more efficiently.

Cited by 20 publications

References 32 publications

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care

Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

Preventing unwanted situations and gaining trust: a qualitative study of older people and families’ experiences with advance care planning in the daily practice of primary care

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