Family physicians' perspectives on advance care planning in community-dwelling elderly patients

• Published in: Canadian family physician Vol. 66; no. 1; pp. e21 - e29
• Main Authors: Ji, Tianshu Angela, Ho, Jordan, McGregor, Margaret J, Kow, Janet
• Format: Journal Article
• Language: English
• Published: College of Family Physicians of Canada 01-01-2020
• Subjects: Advance directives; Family physicians; Medical prognosis; Older people; Patients; Perceptions; Primary care; Qualitative research; Vancouver British Columbia Canada; Canada
• ISSN: 0008-350X; 1715-5258

Objective To explore FPs' self-perceived role in advance care planning (ACP) for community-dwelling elderly patients, including the who, what, when, where, why, and how factors associated with having ACP discussions. Design Qualitative descriptive methodology with semistructured interviews. Setting Greater Vancouver region in British Columbia. Participants Thirteen FPs. Methods Semistructured interviews were conducted with a convenience sample of FPs. Interviews were independently coded and analyzed by 2 investigators. Main findings All participants believed that FPs had the responsibility to ensure that elderly patients received ACP. However, practitioners who were comfortable with other specialists taking the lead were more likely to take a passive role. Most participants did not definitively distinguish end-of-life care from ACP, possibly because discussions frequently occurred late in the disease trajectory. While a minority of physicians approached patients based on older age, most physicians (69%) initiated ACP based on the patient's health status. However, the threshold to begin discussions varied greatly among participants. Physicians often talked about the necessity of dedicating time to these discussions and introduced ACP with the following techniques: normalizing the topic, speaking in general terms, and exploring the patient's understanding of his or her prognosis. Participants expressed conflicting perceptions regarding the effect of ACP on the physician, on the patient's current health, on the patient's future care, and on the patient-physician relationship. As most FPs solely practised in the clinic setting, many were unaware of the direct effects of ACP on patients' end-of-life care. Conclusion Family physicians had varying and often conflicting perspectives on the optimal timing and effects of ACP in community-dwelling elderly patients. More research investigating the effects of ACP on the elderly primary care population is needed.