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

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Julie Stevens¹  Rose Miranda²  Luc Deliens¹  Peter Pype³  Aline De Vleminck²  Koen Pardon² 

[1] End-of-Life Care Research Group, Vrije Universiteit Brussel ,(VUB) and Universiteit Gent, Department of Family Medicine and Chronic Care, VUB, Brussels, Department of Public Health and Primary Care, Universiteit Gent;End-of-Life Care Research Group, VUB and Universiteit Gent, Department of Family Medicine and Chronic Care;End-of-Life Care Research Group, VUB, and Universiteit Gent, Department of Public Health and Primary Care, Universiteit Gent

关键词: advance care planning;    baseline survey;    chronic disease;    general practice;    patient participation;    surveys and questionnaires;   

DOI  :  10.3399/BJGP.2022.0100

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Advance care planning (ACP) has been characterised as a complex process of communication and decision making. For ACP behaviour change, underlying processes such as self-efficacy and readiness are needed. However, studies about which patient characteristics are associated with ACP have mainly focused on whether ACP actions are completed, leaving behaviour change processes unexplored.Aim To assess whether patients’ characteristics and patient-perceived quality of GP ACP communication were associated with patients’ ACP engagement.Design and setting Baseline data were used from the ACP-GP cluster-randomised controlled trial in patients with chronic, life-limiting illness (n = 95).Method Patients completed questionnaires detailing demographic and clinical characteristics, and their perception about their GPs’ 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 was how much ACP information patients received from their GP or the extent to which the GP listened to what was important for the patient to live well or important to the patient regarding future care. Higher overall ACP engagement (P = 0.002) and self-efficacy (P<0.001) were observed in patients who gave a high rating for the extent to which their GP listened to their worries regarding future health.Conclusion This study suggests that GPs providing information about ACP alone is not associated with a patient’s ACP engagement; an important element is to listen to patients’ worries regarding their future health.

【 授权许可】

Free