Family physicians’ perspectives on advance care planning in community-dwelling elderly patients
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".