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‘Advance care planning, general practitioners and patients: a phase II cluster-randomised controlled trial in chronic life-limiting illness’
  1. Sigrid Dierickx1,2,
  2. Koen Pardon1,3,
  3. Peter Pype1,2,
  4. Julie Stevens1,3,
  5. Robert Vander Stichele1,4,
  6. Luc Deliens1,2,3 and
  7. Aline De Vleminck1,3
  1. 1End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
  2. 2Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
  3. 3Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
  4. 4Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
  1. Correspondence to Dr Sigrid Dierickx, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium; Sigrid.Dierickx{at}ugent.be

Abstract

Objectives Although general practice is an ideal setting for ensuring timely initiation of advance care planning (ACP) in people with chronic life-limiting illness, evidence on the effectiveness of ACP in general practice and how it can be implemented is lacking. This study aims to evaluate feasibility and acceptability of study procedures and intervention components of an intervention to facilitate the initiation of ACP in general practice for people with chronic life-limiting illness.

Methods Pilot cluster-randomised controlled trial testing a complex ACP intervention in general practice versus usual care (ClinicalTrials.gov: NCT02775032). We used a mixed methods approach using detailed documentation of the recruitment process, questionnaires and semi-structured interviews.

Results A total of 25 general practitioners (GPs) and 38 patients were enrolled in the study. The intervention was acceptable to GPs and patients, with GPs valuing the interactive training and patients finding ACP conversations useful. However, we found a number of challenges regarding feasibility of recruitment procedures, such GP as recruitment proceeding more slowly than anticipated as well as difficulty applying the inclusion criteria for patients. Some GPs found initiating ACP conversations difficult. The content of the patient booklet was determined to potentially be too complex for patients with a lower health literacy.

Conclusion Although the intervention was well-accepted by GPs and patients, we identified critical points for improvement with regard to the study procedures as well as potential improvements of the intervention components. When these points are addressed, the intervention can proceed to a large-scale, phase III trial to test its effectiveness.

  • chronic conditions
  • communication
  • education and training
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Footnotes

  • LD and ADV are joint senior authors.

  • Contributors ADV, LD, KP, PP and RVS were responsible for the study’s conception and design. SD and ADV were responsible for data collection and analysis and drafted the manuscript. All authors contributed to the interpretation of the data, critically revised the manuscript for important intellectual content and gave final approval for submission. SD, ADV and LD act as guarantors of the work. ADV and LD contributed equally as last author.

  • Funding This study was supported by a grant from Kom op Tegen Kanker. Aline De Vleminck is Postdoctoral Fellow of the Research Foundation Flanders (FWO).

  • Disclaimer The funding sources had no role in the design and conduct of the study, in the collection, management, analysis and interpretation of the data, or in the preparation, review, or approval of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Ethical Review Board of the Brussels University Hospital approved the study protocol and all study materials (B.U.N. 143201628718, 10 August 2016).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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