Evaluation of a process to implement advance care planning conversations in primary care: uptake and patient experience

ABSTRACT Objective Advance care planning (ACP) can support patients in achieving current and future medical care that aligns with their values and goals. In primary care, a lack of standardized processes hinders implementation of ACP conversations. This study reports a quality improvement process to identify and engage patients and clinicians in ACP. Methods Primary care clinicians received training in conversations based on the Serious Illness Conversation Guide and tools to support ACP. In December 2019, patients 65 years of age and older with chronic obstructive pulmonary disease were systematically identified, mailed ACP resources and telephoned by the clinic to invite them to an ACP appointment. We tracked the attendance of the patients and evaluated patient experience using a survey. Results Of the 91 patients telephoned, 50 were reached, and 27 attended the appointment. Further efforts were suspended in March 2020 due to the COVID-19 pandemic. Thirteen patients completed the survey. There were statistically significant increases in the patient’s perception of being heard and understood by their physician, feeling hopeful about quality of life and feeling peaceful. Conclusion This study provides evidence that with training, tools and processes, patients and primary care clinicians can be effectively engaged in ACP conversations. KEY MESSAGES What was already known? Training resources exist for help clinicians enhance their advance care planning communication skills Besides a need for skills, other practical challenges exist in implementing advance care planning in family practice What are the new findings? Structured patient identification and preparation can facilitate advance care planning conversations in family practice Patients reported positive experiences of the conversations What is their significance? Clinical: It is important to move beyond clinician training alone to implement processes in family practice to trigger advance care planning conversations Research: Further research to identify effective scalable approaches to triggering and implementing advance care planning conversations in family practice would be beneficial

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