Jolien J Glaudemans1, Anja E de Jong1, Bregje D Onwuteaka Philipsen2, Jan Wind3, Dick L Willems1. 1. Section of Medical Ethics, Department of General Practice, Academic Medical Centre, University of Amsterdam, the Netherlands. 2. Department of public and occupational health, Amsterdam Public Health Research Institute Expertise Centre for Palliative Care, VU Medical Centre, the Netherlands. 3. Department of General Practice, Academic Medical Centre, University of Amsterdam, the Netherlands.
Abstract
BACKGROUND: Few older people benefit from advance care planning (ACP), due to several barriers related to primary care professionals, such as insufficient knowledge, negative beliefs and a lack of time. Information on overcoming these barriers is limited. We assumed primary care professionals experienced in ACP with older patients are likely to have learned how to overcome these barriers. OBJECTIVE: To investigate how Dutch primary care professionals experienced in ACP with older patients overcome these barriers. METHODS: A qualitative study, based on semi-structured interviews, among a purposive sample of 14 Dutch primary care professionals experienced in ACP with older people. Transcripts were thematically analysed. RESULTS: We interviewed eight general practitioners (GPs), three nurses and three elderly care physicians, experienced in ACP with older people. Respondents overcame their own insufficient knowledge and skills, as well as their negative attitudes and beliefs by gaining experience through practicing ACP in their daily practices, exchanging and reflecting on those experiences with peers, pursuing continuing education, teaching and participating in research. To overcome patients' and families' lack of initiative and openness to ACP, respondents prepared them for further steps in ACP. To overcome a lack of time, respondents used tools and information communication technology, delegated parts of ACP to other primary care professionals, acquired financing and systematized documentation of ACP. CONCLUSION: 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.
BACKGROUND: Few older people benefit from advance care planning (ACP), due to several barriers related to primary care professionals, such as insufficient knowledge, negative beliefs and a lack of time. Information on overcoming these barriers is limited. We assumed primary care professionals experienced in ACP with older patients are likely to have learned how to overcome these barriers. OBJECTIVE: To investigate how Dutch primary care professionals experienced in ACP with older patients overcome these barriers. METHODS: A qualitative study, based on semi-structured interviews, among a purposive sample of 14 Dutch primary care professionals experienced in ACP with older people. Transcripts were thematically analysed. RESULTS: We interviewed eight general practitioners (GPs), three nurses and three elderly care physicians, experienced in ACP with older people. Respondents overcame their own insufficient knowledge and skills, as well as their negative attitudes and beliefs by gaining experience through practicing ACP in their daily practices, exchanging and reflecting on those experiences with peers, pursuing continuing education, teaching and participating in research. To overcome patients' and families' lack of initiative and openness to ACP, respondents prepared them for further steps in ACP. To overcome a lack of time, respondents used tools and information communication technology, delegated parts of ACP to other primary care professionals, acquired financing and systematized documentation of ACP. CONCLUSION: 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.
Authors: Jolien Jeltje Glaudemans; Eric Moll van Charante; Jan Wind; John Jacob Oosterink; Dick Ludolf Willems Journal: BMJ Open Date: 2018-11-25 Impact factor: 2.692