BACKGROUND: Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging. AIM: To assess the feasibility of implementing advance care planning in UK primary care. DESIGN OF STUDY: Mixed methods evaluation of a pilot educational intervention. SETTING: Four general practices in south-east Scotland. METHOD: Interviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK. RESULTS: End-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a 'good death'. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of 'tick-box' approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care. CONCLUSION: A clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes.
BACKGROUND: Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging. AIM: To assess the feasibility of implementing advance care planning in UK primary care. DESIGN OF STUDY: Mixed methods evaluation of a pilot educational intervention. SETTING: Four general practices in south-east Scotland. METHOD: Interviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK. RESULTS: End-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a 'good death'. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of 'tick-box' approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care. CONCLUSION: A clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes.
Authors: Josephine M Clayton; Karen M Hancock; Phyllis N Butow; Martin H N Tattersall; David C Currow; Jonathan Adler; Sanchia Aranda; Kirsten Auret; Fran Boyle; Annette Britton; Richard Chye; Katy Clark; Patricia Davidson; Jan Maree Davis; Afaf Girgis; Sara Graham; Janet Hardy; Kate Introna; John Kearsley; Ian Kerridge; Linda Kristjanson; Peter Martin; Amanda McBride; Anne Meller; Geoffrey Mitchell; Alison Moore; Beverley Noble; Ian Olver; Sharon Parker; Matthew Peters; Peter Saul; Cameron Stewart; Lyn Swinburne; Bernadette Tobin; Kathryn Tuckwell; Patsy Yates Journal: Med J Aust Date: 2007-06-18 Impact factor: 7.738
Authors: Adam D Schickedanz; Dean Schillinger; C Seth Landefeld; Sara J Knight; Brie A Williams; Rebecca L Sudore Journal: J Am Geriatr Soc Date: 2009-01 Impact factor: 5.562
Authors: Sharon M Parker; Josephine M Clayton; Karen Hancock; Sharon Walder; Phyllis N Butow; Sue Carrick; David Currow; Davina Ghersi; Paul Glare; Rebecca Hagerty; Martin H N Tattersall Journal: J Pain Symptom Manage Date: 2007-05-25 Impact factor: 3.612
Authors: Karen Hancock; Josephine M Clayton; Sharon M Parker; Sharon Wal der; Phyllis N Butow; Sue Carrick; David Currow; Davina Ghersi; Paul Glare; Rebecca Hagerty; Martin H N Tattersall Journal: Palliat Med Date: 2007-09 Impact factor: 4.762
Authors: Aline De Vleminck; Dirk Houttekier; Koen Pardon; Reginald Deschepper; Chantal Van Audenhove; Robert Vander Stichele; Luc Deliens Journal: Scand J Prim Health Care Date: 2013-12 Impact factor: 2.581