TY - JOUR
T1 - Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners
AU - Glaudemans, Jolien Jeltje
AU - Moll van Charante, Eric
AU - Wind, Jan
AU - Oosterink, John Jacob
AU - Willems, Dick Ludolf
PY - 2018
Y1 - 2018
N2 - OBJECTIVES: Advance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice. DESIGN, SETTING AND PARTICIPANTS: A qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews. RESULTS: Approaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive geriatric assessments and periodic assessments. Meetings were aimed at making agreements in anticipation of future care, at providing information and encouraging older people to take further steps in ACP. With ad hoc approaches, respondents discussed only one or two topics related to the near future. Ad hoc ACP was mainly done with deteriorating patients or when patients or family initiated ACP. Systematic and ad hoc approaches were used simultaneously or sequentially and were both used for initiating and following up on ACP. Due to a lack of time and knowledge of other occasions and topics than the ones respondents used, respondents seemed to underuse many occasions and topics. CONCLUSIONS: Awareness of appropriate systematic and ad hoc approaches for ACP, and the focus on providing information and encouraging older people to take further steps in ACP reported in this study can support GPs and improve older patients' access to ACP.
AB - OBJECTIVES: Advance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice. DESIGN, SETTING AND PARTICIPANTS: A qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews. RESULTS: Approaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive geriatric assessments and periodic assessments. Meetings were aimed at making agreements in anticipation of future care, at providing information and encouraging older people to take further steps in ACP. With ad hoc approaches, respondents discussed only one or two topics related to the near future. Ad hoc ACP was mainly done with deteriorating patients or when patients or family initiated ACP. Systematic and ad hoc approaches were used simultaneously or sequentially and were both used for initiating and following up on ACP. Due to a lack of time and knowledge of other occasions and topics than the ones respondents used, respondents seemed to underuse many occasions and topics. CONCLUSIONS: Awareness of appropriate systematic and ad hoc approaches for ACP, and the focus on providing information and encouraging older people to take further steps in ACP reported in this study can support GPs and improve older patients' access to ACP.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85057270897&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30478126
U2 - https://doi.org/10.1136/bmjopen-2018-024762
DO - https://doi.org/10.1136/bmjopen-2018-024762
M3 - Article
C2 - 30478126
SN - 2044-6055
VL - 8
SP - e024762
JO - BMJ Open
JF - BMJ Open
IS - 11
ER -