Advance care planning in primary care: a retrospective medical record study among patients with different illness trajectories

BMC Palliative Care

Y. Engels¹  H. Schers²  Yvonne A. C. Bekker³  A. Stef Groenewoud³  Gert P. Westert³  Ankie F. Suntjens³ 

[1] Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Medicine, Nijmegen, the Netherlands;Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands;Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, PO Box 9101, 6500, Nijmegen, HB, the Netherlands;

关键词: Advance care planning;    Primary care;    General practice;    General practitioner;    Medical records;    End of life care;   

DOI  :  10.1186/s12904-022-00907-6

来源: Springer

【 摘 要 】

BackgroundAdvance Care Planning (ACP) enables physicians to align healthcare with patients’ wishes, reduces burdensome life-prolonging medical interventions, and potentially improves the quality of life of patients in the last phase of life. However, little objective information is available about the extent to which structured ACP conversations are held in general practice.Our aim was to examine the documentation of ACP for patients with cancer, organ failure and multimorbidity in medical records (as a proxy for ACP application) in Dutch general practice.MethodsWe chose a retrospective medical record study design in seven primary care facilities. Medical records of 119 patients who died non-suddenly (55 cancer, 28 organ failure and 36 multimorbidity) were analysed. Other variables were: general characteristics, data on ACP documentation, correspondence between medical specialist and general practitioner (GP), and healthcare utilization in the last 2 years of life.ResultsIn 65% of the records, one or more ACP items were registered by the GP. Most often documented were aspects regarding euthanasia (35%), the preferred place of care and death (29%) and concerns and hopes towards the future (29%). Median timing of the first ACP conversation was 126 days before death (inter-quartile range (IQR) 30–316). ACP was more often documented in patients with cancer (84%) than in those with organ failure (57%) or multimorbidity (42%) (p = 0.000). Patients with cancer had the most frequent (median 3 times, IQR 2–5) and extensive (median 5 items, IQR 2–7) ACP consultations.ConclusionDocumentation of ACP items in medical records by GPs is present, however limited, especially in patients with multimorbidity or organ failure. We recommend more attention for – and documentation of – ACP in daily practice, in order to start anticipatory conversations in time and address the needs of all people living with advanced conditions in primary care.

【 授权许可】

CC BY