Karendeep Somal1, Tony Foley2. 1. School of Medicine, University College Cork, Cork, Ireland. 117105107@umail.ucc.ie. 2. Department of General Practice, University College Cork, Cork, Ireland.
Abstract
BACKGROUND: Planning for end of life (EOL) care has become an important consideration for doctors and patients in the context of longer life expectancy in most high-income countries. Advance care plans (ACPs) allow individuals to make plans for future healthcare practices for when they no longer have the capacity to make such decisions. It has been suggested that general practitioners (GPs) have the ideal relationship with patients to facilitate this process. However, the uptake of ACPs still remains low, prompting the need to understand the views of GPs regarding ACPs. AIM: The aim of this study was to assess the knowledge and attitudes of GPs regarding ACPs and to identify barriers in implementing ACPs into practice. DESIGN AND SETTING: A cross-sectional descriptive study was conducted with GPs in county Cork and Kerry. METHODS: A questionnaire was adapted from two previously published studies, piloted and posted to GPs. Two hundred thirty-seven questionnaires were posted. RESULTS: Seventy-five questionnaires were completed, representing a 31.7% response rate. Findings revealed that GPs have positive attitudes towards ACPS, although there is an inadequate understanding of ACPs. In particular, GPs are challenged by defining the right moment to initiate EOL discussions, their patients' unawareness of ACPs, and lack of time during consultations. CONCLUSION: In order to improve their implementation, workshops and courses should be developed to increase GPs' knowledge and confidence. Additionally, the healthcare system should be adapted, supporting GPs to facilitate these important discussions to take place.
BACKGROUND: Planning for end of life (EOL) care has become an important consideration for doctors and patients in the context of longer life expectancy in most high-income countries. Advance care plans (ACPs) allow individuals to make plans for future healthcare practices for when they no longer have the capacity to make such decisions. It has been suggested that general practitioners (GPs) have the ideal relationship with patients to facilitate this process. However, the uptake of ACPs still remains low, prompting the need to understand the views of GPs regarding ACPs. AIM: The aim of this study was to assess the knowledge and attitudes of GPs regarding ACPs and to identify barriers in implementing ACPs into practice. DESIGN AND SETTING: A cross-sectional descriptive study was conducted with GPs in county Cork and Kerry. METHODS: A questionnaire was adapted from two previously published studies, piloted and posted to GPs. Two hundred thirty-seven questionnaires were posted. RESULTS: Seventy-five questionnaires were completed, representing a 31.7% response rate. Findings revealed that GPs have positive attitudes towards ACPS, although there is an inadequate understanding of ACPs. In particular, GPs are challenged by defining the right moment to initiate EOL discussions, their patients' unawareness of ACPs, and lack of time during consultations. CONCLUSION: In order to improve their implementation, workshops and courses should be developed to increase GPs' knowledge and confidence. Additionally, the healthcare system should be adapted, supporting GPs to facilitate these important discussions to take place.
Keywords:
Advance care; Advance care plans; Clinical decision making; End of life; End of life care; Family doctor; Family doctors; Family medicine; Frailty; General practice; General practitioner; General practitioners; Palliative care; Primary care; Terminal care