Advance care planning in Dutch primary care: a pre/post-implementation study

Background Despite known advantages of advance care planning (ACP) and a positive attitude towards ACP by older people living in the community and general practitioners (GPs), such conversations are not yet commonplace in GP practices. Aim To implement ACP as part of routine care in general practice and thereby increasing the number of ACP conversations and advance directives; to investigate characteristics of older people with and without an ACP conversation. Methods (1) A pre-evaluation and post-evaluation study using questionnaire data from people aged 75 years or older living in the community. (2) A prospective study using data provided by healthcare professionals (people they started an ACP conversation with). Results After implementation of ACP, significantly more people had spoken to their GP about hospitalisations, intensive care admission and treatment preferences in certain circumstances, compared with before. Advance directives were drawn up more often. People who had an ACP conversation were older, have had a cerebrovascular accident, had a clear idea about future health problems, had a preference to start ACP before they were ill, already had an ACP conversation at pre-measurement and indicated at pre-measurement that their GP knows their preferences. Conclusion Results in number of ACP conversations and advance drectives were modest but positive. ACP was implemented as routine care. GPs select people with whom they have a conversation. This can be an efficient use of time, but there is a risk that certain groups may be underserved (for example, patients with multimorbidity or patients with less health skills).

Automated summary

Despite positive attitudes towards advance care planning (ACP) by older people and general practitioners, such conversations are not yet common in GP practices. The implementation of ACP in routine care led to more discussions about hospitalizations, intensive care, and treatment preferences, and more advance directives were drawn up. However, there is a risk that certain groups, such as patients with multiple chronic conditions or lower health literacy, may not be adequately served.