Barriers to Advance Care Planning in Cancer, Heart Failure and Dementia Patients A Focus Group Study on General Practitioners Views and Experiences.docVIP

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Barriers to Advance Care Planning in Cancer, Heart Failure and Dementia Patients A Focus Group Study on General Practitioners Views and Experiences.doc

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Barriers to Advance Care Planning in Cancer, Heart Failure and Dementia Patients A Focus Group Study on General Practitioners Views and Experiences

BarrierstoAdvanceCarePlanninginCancer,Heart FailureandDementiaPatients:AFocusGroupStudyon GeneralPractitioners’ViewsandExperiences AlineDeVleminck1*,KoenPardon1,KimBeernaert1,ReginaldDeschepper1,DirkHouttekier1, ChantalVanAudenhove2,LucDeliens1,3,RobertVanderStichele1,4 1End-of-LifeCareResearchgroup,GhentUniversityVrijeUniversiteitBrussel(VUB),Brussels,Belgium,2LUCAS(CenterforCareResearchandConsultancy),Catholic University of Louvain, Louvain, Belgium, 3Department of Public and Occupational Health, and EMGO+ Institute for Health and Care Research, VU University Medical Centre,Amsterdam,TheNetherlands,4HeymansInstituteofPharmacology,GhentUniversity,Ghent,Belgium Abstract Background:Thelong-termandoftenlifelongrelationshipofgeneralpractitioners(GPs)withtheirpatientsisconsideredto makethemtheidealinitiatorsofadvancecareplanning(ACP).However,ingeneraltheincidenceofACPdiscussionsislow andACPseemstooccurmoreoftenforcancerpatientsthanforthosewithdementiaorheartfailure. Objective: To identify the barriers, from GPs’ perspective, to initiating ACP and to gain insight into any differences in barriersbetweenthetrajectoriesofpatientswithcancer,heartfailureanddementia. Method:FivefocusgroupswereheldwithGPs(n=36)inFlanders,Belgium.Thefocusgroupdiscussionsweretranscribed verbatimandanalyzedusingthemethodofconstantcomparativeanalysis. Results:Threetypesofbarriersweredistinguished:barriersrelatingtotheGP,tothepatientandfamilyandtothehealth caresystem.Incancerpatients,aGP’slackofknowledgeabouttreatmentoptionsandthelackofstructuralcollaboration betweentheGPandspecialistwereexpressedasbarriers.Barriersthatoccuredmoreoftenwithheartfailureanddementia were the lack of GP familiarity with the terminal phase, the lack of key moments to initiate ACP, the patient’s lack of awarenessoftheirdiagnosisandprognosisandthefactthatpatientsdidnotofteninitiatesuchdiscussionsthemselves.The futurelackofdecision-makingcapacityofdementiapatientswasreportedbytheGPsasaspecificbarrierfortheinitiation ofACP.