Incorporating an advance care planning screening tool into routine health assessments with older people

Abstract

General practice is arguably the ideal setting to initiate advance care planning (ACP), but there are many barriers. This pilot study was designed to assess the feasibility, acceptability and perceived utility of a nurse-facilitated screening interview to initiate ACP with older patients in general practice. Patients were recruited from four general practices in Sydney, Australia. General practice nurses administered the ACP screening interview during routine health assessments. Patients and nurses completed a follow-up questionnaire consisting of questions with Likert responses, as well as open-ended questions. Descriptive statistics and content analysis were used to analyse the data. Twenty-four patients participated; 17 completed the follow-up questionnaire. All patients found the ACP screening interview useful and most felt it would encourage them to discuss their wishes further with their family and general practitioner. Several patients were prompted to consider legally appointing their preferred substitute decision-maker. All six participating nurses found the screening interview tool useful for initiating discussions about ACP and substitute decision-making. This nurse facilitated screening tool provides a simple, acceptable and feasible approach to introducing ACP to older general practice patients during routine health assessments.

Barriers and facilitators to nurse-led advance care planning and palliative care practice change in primary healthcare: a qualitative study

“…The GPN interview participants stated that, in fact, the Advance Project training gave them the confidence and structure to initiate ACP conversations. A previous pilot study showed that a GPN-led approach to initiating ACP discussions with older general practice patients during routine health assessments was acceptable and feasible for both nurses and patients (Franklin et al 2020). Miller et al (2019) similarly reported that with adequate training and mentoring support, GPNs are able to initiate and facilitate ACP conversations with patients, and, furthermore, their involvement in ACP can have significant benefits for patients.…”

“…One way to facilitate early access to palliative care and advance care planning (ACP) is through primary care (Franklin et al 2020). The growth of the general practice nursing workforce creates an opportunity for nurses to fill this gap in care delivery (Stephen et al 2018;Rogers et al 2019;Franklin et al 2020). The definitions of 'advance care planning', 'palliative care' and 'supportive care' used in this study are provided in Box 1.…”

“…Existing resources to support GPs in the area of ACP and palliative care are available (e.g. Program of Experience in the Palliative Approach 2021); however, there are frequent reports that GPs lack time to initiate ACP or palliative care needs assessment (Franklin et al 2020). A recent review of barriers to GPN-led chronic disease management interventions reported inadequate GPN preparation, lack of support, workload and lack of funding as key barriers to interventions (Stephen et al 2018).…”

Dying still matters in the age of COVID-19

“…Some GPs are worried that ACP could increase patient anxiety, but a recent study in the Australian general practice setting showed a high level of acceptability of patients in being asked about ACP. 4 A patient who expresses an interest in ACP could be given written information to read, including information about choosing and appointing a substitute decision maker (SDM), and have an arrangement made for follow-up consultations to further discuss the topic. The ACP discussion itself follows a broad outline and should include a discussion about the patient's preferred SDM, their concerns about their future healthcare, and any values or preferences they would want to be taken into account about their healthcare if they were to become very unwell.…”

Documenting plans for care: advance care directives and the 7-step pathway in the acute care context

“…In general terms, advance care planning involves the discussion and documentation of an individual's values and preferences to guide their future healthcare should they lose the capacity to make or communicate treatment decisions [8,9]. This can involve the individual's completion of an Advance Care Directive (ACD), a legislated and common-law instrument which may include the appointment of a substitute decision-maker and binding refusals of treatment [9].…”