Rather than a one-time documentation of care goals and preferences, advance care planning (ACP) is currently conceptualized as an ongoing communication process that should be initiated early in the disease trajectory. However, ACP is often still initiated too late, when a medical emergency occurs or the patient is near death. General practitioners (GPs) play a critical role in timely initiation of ACP. By discussing ACP with their GP, patients have time to think about and communicate their preferences, increasing their engagement with the process. However, little evidence exists of how GPs and patients can initiate these conversations effectively.
This randomized controlled trial encompasses two main aims:
1. To evaluate the effects of a complex, multi-component advance care planning (ACP) intervention in patients with a chronic, life-limiting illness in the general practice setting (outcome evaluation).
2. To evaluate the implementation process of the ACP intervention (process evaluation)
In this project, we will conduct a randomized-controlled trial of an ACP intervention for general practice, using recently-developed outcome measures which highlight ACP as an ongoing process. The intervention consists of the following components: 1) ACP knowledge and communication skills training for the GP, 2) a workbook about ACP for the patient, 3) at least 2 structured ACP conversations between GP and patient, and 4) documentation of the outcome of the conversations by the GP. A process evaluation will also be carried out to evaluate how the intervention was implemented and to identify barriers and facilitators to the intervention.
This study will provide valuable evidence for the effects of ACP in general practice and for the effectiveness of tools developed to enable these conversations.