Are specialist-provided end-of-life scenarios key to initiation of advance care planning in primary care? A mixed-methods study.

Autor:	Poelman SW; Department of Primary and Community Care, Radboudumc, Nijmegen, Gelderland, The Netherlands., Ermers DJM; Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands., Schers HJ; Department of Primary and Community Care, Radboudumc, Nijmegen, Gelderland, The Netherlands., Vissers KCP; Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands., Veldhoven CMM; Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands., Kuip EJM; Department of Medical Oncology and Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands., Perry M; Department of Geriatrics, Radboudumc, Nijmegen, Gelderland, The Netherlands.
Jazyk:	angličtina
Zdroj:	Palliative & supportive care [Palliat Support Care] 2024 Feb 16, pp. 1-9. Date of Electronic Publication: 2024 Feb 16.
DOI:	10.1017/S1478951523002055
Abstrakt:	Objectives: Specialist-provided end-of-life scenarios (SP-EOLS) may improve advance care planning (ACP) implementation in primary care by helping overcome barriers such as uncertain prognosis and poor interprofessional collaboration. We aimed to explore the current use and potential impact of SP-EOLS on ACP in Dutch primary care. Methods: We performed a mixed-methods study. From patients discussed in a hospital-based academic palliative care multidisciplinary team meeting between 2016 and 2019 and died, we collected primary care electronic medical records data on SP-EOLS, actual EOLS, and ACP initiation and applied descriptive and comparative analyses. Subsequently, we interviewed general practitioners (GPs) and thematically analyzed the transcripts. Results: In 69.7% of 66 reviewed patient files, SP-EOLS were found. In patients whose GP had received SP-EOLS, ACP conversations were more often reported (92.0 vs. 61.0%, p = 0.006). From 11 GP interviews, we identified 4 themes: (1) SP-EOLS guide GPs, patients, and relatives when dealing with an uncertain future perspective; (2) SP-EOLS provide continuity of care between primary and secondary/tertiary care; (3) SP-EOLS should be tailored to the individual patient; and (4) SP-EOLS need to be personalized and uniformly transferred to GPs. Significance of Results: SP-EOLS may facilitate ACP conversations by GPs. They have the potential to help overcome existing barriers to ACP implementation by providing guidance and supporting interprofessional collaboration. Future research should focus on improving SP-EOLS and tailor them to the needs of all end users, focusing on improving their effect on ACP conversations.
Databáze:	MEDLINE
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