Background General practitioners (GPs) are well placed for identifying patients in need of advance care planning (ACP) and initiating ACP before acute deterioration in their illness trajectory. However, little is known about the frequency and contents of ACP discussions in primary care. We aimed to explore the frequency and contents of ACP discussions among patients, family members, and GPs.
Methods A multicenter, cross-sectional, observational study was conducted at 17 clinics with 22 GPs. In March 2017, each GP set an arbitrary day in advance and we enrolled all patients aged ≥65 years who visited the GPs on that day. We explored the frequency and topics of ACP discussions. We identified patients at risk of deterioration and dying based on the Japanese version of the Supportive and Palliative Care Indicators Tool (SPICT™).
Result In total, 382 patients with a mean age of 77.4 ± 7.9 years were included. Twenty-three patients (6.0%) had ACP discussions with their GP. Of 66 patients at risk of deterioration and dying, 13 patients (19.7%) had ACP discussions with their GP. The most common topic among patients overall was anticipated declines in activities of daily living (ADLs), but the topic of surrogate decision-makers was the most common with neurological patients.
Conclusion Primary care patients aged ≥65 years did not necessarily have frequent ACP discussions with their GP, but discussions were more common with patients at risk of deterioration and dying. The anticipated declines in ADLs was most frequently discussed topic among patients, family members, and GPs.
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