Emotional cues and concerns of patients with a life limiting, chronic illness during advance care planning conversations in general practice*

Objective: To explore a) to what extent patients with serious illness express emotional cues and concerns during advance care planning (ACP) conversations with their general practitioner (GP), b) the content of cues/concerns and c) GPs' responses to cues/concerns. Methods: Cues/concerns and GPs' responses in 20 conversations were coded using the Verona Codes (VR-CoDES and Verona Codes-P). A qualitative thematic analysis was used to identify overarching themes within the content of the cues/concerns. Results: A total of 216 cues/concerns were identified (range: 1-28; mean: 13) in 85% of conversations; with 85% of these being cues/implicit expressions of emotions. In 72% of responses, the GP provided space for the patient to elaborate on cues/concerns. The most common theme cues/concerns were expressed about was the conse-quences of illness on quality of life and burdening others. Conclusion: Emotions were mainly communicated implicitly as cues and the content varied greatly. The amount of cues/concerns expressed show that ACP can evoke many emotions. Practice implications: GPs should be attentive to implicit expressions of emotions as these provide opportunities to engage patients in tailored ACP conversations. As patients expressed many cues/concerns, GPs are recommended to have recurrent conversations with patients and actively ask about diverse ACP topics.

Automated summary

This study aimed to explore the extent to which patients with serious illness express emotional cues and concerns during advance care planning (ACP) conversations with their general practitioner (GP), as well as the content of cues/concerns and GPs' responses. The Verona Codes were used to code cues/concerns and responses in 20 conversations. A qualitative thematic analysis identified overarching themes within the content of the cues/concerns. The results showed that emotions were mainly communicated implicitly as cues and the content varied greatly. GPs should be attentive to implicit expressions of emotions and have recurrent conversations with patients about diverse ACP topics.