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Actual timing versus GPs’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study

BACKGROUND: Timely initiation of advance care planning (ACP) in general practice is challenging, especially in patients with non-malignant conditions. Our aim was to investigate how perceived optimal timing of ACP initiation and its triggers relate to recorded actual timing in patients with cancer,...

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Autores principales: Tros, Willemijn, van der Steen, Jenny T., Liefers, Janine, Akkermans, Reinier, Schers, Henk, Numans, Mattijs E., van Peet, Petra G., Groenewoud, A. Stef
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749277/
https://www.ncbi.nlm.nih.gov/pubmed/36514002
http://dx.doi.org/10.1186/s12875-022-01940-3
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author Tros, Willemijn
van der Steen, Jenny T.
Liefers, Janine
Akkermans, Reinier
Schers, Henk
Numans, Mattijs E.
van Peet, Petra G.
Groenewoud, A. Stef
author_facet Tros, Willemijn
van der Steen, Jenny T.
Liefers, Janine
Akkermans, Reinier
Schers, Henk
Numans, Mattijs E.
van Peet, Petra G.
Groenewoud, A. Stef
author_sort Tros, Willemijn
collection PubMed
description BACKGROUND: Timely initiation of advance care planning (ACP) in general practice is challenging, especially in patients with non-malignant conditions. Our aim was to investigate how perceived optimal timing of ACP initiation and its triggers relate to recorded actual timing in patients with cancer, organ failure, or multimorbidity. METHODS: In this mixed-methods study in the Netherlands, we analysed health records selected from a database with primary care routine data and with a recorded ACP conversation in the last two years before death of patients who died with cancer, organ failure, or multimorbidity. We compared actual timing of ACP initiation as recorded in health records of 51 patients with the perceived optimal timing as determined by 83 independent GPs who studied these records. Further, to identify and compare triggers for GPs to initiate ACP, we analysed the health record documentation around the moments of the recorded actual timing of ACP initiation and the perceived optimal timing of ACP initiation. We combined quantitative descriptive statistics with qualitative content analysis. RESULTS: The recorded actual timing of ACP initiation was significantly closer to death than the perceived optimal timing in patients with cancer (median 88 vs. 111 days before death (p = 0.049)), organ failure (227 vs. 306 days before death (p = 0.02)) and multimorbidity (113 vs. 338 days before death (p = 0.006)). Triggers for recorded actual versus perceived optimal timing were similar across the three groups, the most frequent being ‘expressions of patients’ reflections or wishes’ (14% and 14% respectively) and ‘appropriate setting’ (10% and 13% respectively). CONCLUSION: ACP in general practice was initiated and recorded later in the illness trajectory than considered optimal, especially in patients with organ failure or multimorbidity. As triggers were similar for recorded actual and perceived optimal timing, we recommend that GPs initiate ACP shortly after a trigger is noticed the first time, rather than wait for additional or more evident triggers when the illness is in an advanced stage. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-022-01940-3.
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spelling pubmed-97492772022-12-15 Actual timing versus GPs’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study Tros, Willemijn van der Steen, Jenny T. Liefers, Janine Akkermans, Reinier Schers, Henk Numans, Mattijs E. van Peet, Petra G. Groenewoud, A. Stef BMC Prim Care Research BACKGROUND: Timely initiation of advance care planning (ACP) in general practice is challenging, especially in patients with non-malignant conditions. Our aim was to investigate how perceived optimal timing of ACP initiation and its triggers relate to recorded actual timing in patients with cancer, organ failure, or multimorbidity. METHODS: In this mixed-methods study in the Netherlands, we analysed health records selected from a database with primary care routine data and with a recorded ACP conversation in the last two years before death of patients who died with cancer, organ failure, or multimorbidity. We compared actual timing of ACP initiation as recorded in health records of 51 patients with the perceived optimal timing as determined by 83 independent GPs who studied these records. Further, to identify and compare triggers for GPs to initiate ACP, we analysed the health record documentation around the moments of the recorded actual timing of ACP initiation and the perceived optimal timing of ACP initiation. We combined quantitative descriptive statistics with qualitative content analysis. RESULTS: The recorded actual timing of ACP initiation was significantly closer to death than the perceived optimal timing in patients with cancer (median 88 vs. 111 days before death (p = 0.049)), organ failure (227 vs. 306 days before death (p = 0.02)) and multimorbidity (113 vs. 338 days before death (p = 0.006)). Triggers for recorded actual versus perceived optimal timing were similar across the three groups, the most frequent being ‘expressions of patients’ reflections or wishes’ (14% and 14% respectively) and ‘appropriate setting’ (10% and 13% respectively). CONCLUSION: ACP in general practice was initiated and recorded later in the illness trajectory than considered optimal, especially in patients with organ failure or multimorbidity. As triggers were similar for recorded actual and perceived optimal timing, we recommend that GPs initiate ACP shortly after a trigger is noticed the first time, rather than wait for additional or more evident triggers when the illness is in an advanced stage. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-022-01940-3. BioMed Central 2022-12-13 /pmc/articles/PMC9749277/ /pubmed/36514002 http://dx.doi.org/10.1186/s12875-022-01940-3 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Tros, Willemijn
van der Steen, Jenny T.
Liefers, Janine
Akkermans, Reinier
Schers, Henk
Numans, Mattijs E.
van Peet, Petra G.
Groenewoud, A. Stef
Actual timing versus GPs’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study
title Actual timing versus GPs’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study
title_full Actual timing versus GPs’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study
title_fullStr Actual timing versus GPs’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study
title_full_unstemmed Actual timing versus GPs’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study
title_short Actual timing versus GPs’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study
title_sort actual timing versus gps’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749277/
https://www.ncbi.nlm.nih.gov/pubmed/36514002
http://dx.doi.org/10.1186/s12875-022-01940-3
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