Background Advance care planning (ACP) is an iterative communication process about patients’ values and preferences for future care. The general practice setting can provide opportunities for ACP, but deficits remain in its initiation due to barriers at the patient, general practitioner (GP), or health care system level. A complex intervention may be necessary to reduce barriers. We aimed to evaluate the effects of a complex ACP intervention for patients with chronic, life-limiting illness in general practice (ACP-GP).
Method Cluster-randomized controlled trial with randomization at the GP level. The intervention consists of a patient workbook, GP training, ACP conversations, and a documentation template. Outcomes were the 15-item ACP Engagement Survey for patients and the ACP Self-Efficacy Scale for GPs. Linear mixed models evaluated differences at 3 months (T1, effectiveness evaluation) and 6 months (T2) post-baseline. Analysis was per intention-to-treat.
Results 35 GPs and 95 patients were randomized. Patient ACP engagement did not differ between the intervention and control group at T1 (baseline-adjusted mean difference, 0.34; 95% CI, -0.02 to 0.69; p=0.062) or T2 (baseline-adjusted mean difference, 0.20; 95% CI, -0.17 to 0.57; p = 0.28). for GP ACP self-efficacy, there were no significant differences between groups at T1 (baseline-adjusted mean difference, 0.16; 95% CI, -0.04 to 0.35; p = 0.11) or at T2 (baseline-adjusted mean difference, 0.11; 95% CI, -0.09 to 0.31; p = 0.27).
Conclusion ACP-GP did not improve patient engagement and GP self-efficacy more than usual care. Both groups showed patterns of increase from baseline. Trial procedures and the COVID-19 pandemic that coincided with the trial may have increased awareness about ACP, which may have also stimulated the control group to conduct more ACP than expected. It may be necessary to also look further at what patients and surrogate decision makers want and need from the ACP process.