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General practitioner advance care planning knowledge and attitudes: ACP-GP cluster-randomised controlled trial
  1. Frederick Daenen1,2,
  2. Julie Stevens1,2,
  3. Luc Deliens1,2,
  4. Peter Pype1,3,
  5. Kim Beernaert1,3,
  6. Aline De Vleminck1,2 and
  7. Koen Pardon1,2
  1. 1End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
  2. 2Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
  3. 3Department of Public Health and Primary Care, Ghent University, Gent, Belgium
  1. Correspondence to Dr Frederick Daenen, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels 1090, Belgium; frederick.daenen{at}vub.be

Abstract

Objectives Advance care planning (ACP) supports adults understanding and sharing their values, goals, and preferences regarding future medical care. General practitioners (GPs) are key figures in conducting ACP conversations with patients. GPs’ ACP knowledge and attitudes have been identified as potential barriers. This study evaluates the effects of ACP-GP, a complex ACP intervention, on GPs’ knowledge and attitudes.

Methods A phase-III cluster-randomised controlled trial. 35 Belgian GPs participated. The intervention included a training for GPs, ACP conversations, a patient workbook, and a documentation template. GPs’ knowledge and attitudes were assessed using an adaptation of the Next Steps questionnaire, at baseline, three, and six months postintervention. Generalised estimating equations were applied to analyse the data.

Results Analyses showed no intervention effect on GPs’ knowledge (W(2)=4.18, p=.123) and attitudes (all W(2)<3.85, all p>.146) compared with the control group.

Conclusions The ACP-GP intervention did not improve GPs’ knowledge and attitudes. Failure to detect an effect may stem from a ceiling effect, with GPs scoring high on baseline outcomes across groups. Questionnaires may require fine-tuning to accurately map their suggested role as potential barriers.

Trial registration number Prospectively registered at ISRCTN (ISRCTN12995230) on 19 June 2020.

  • Advance Care Planning
  • Palliative Care

Data availability statement

The datasets are available upon request. Requests may be addressed to the first author. Every request will be evaluated on an individual basis and the ethics committee of the Vrije Universiteit Brussels will be contacted for approval before any sharing of participant-level data.

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Data availability statement

The datasets are available upon request. Requests may be addressed to the first author. Every request will be evaluated on an individual basis and the ethics committee of the Vrije Universiteit Brussels will be contacted for approval before any sharing of participant-level data.

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Footnotes

  • Contributors Contributions: FD: Writing, analyses; JS: Design, review; LD: Design, review; PP: Design, review; KB: Review; ADV: Design, review; KP: Design, review. ADV and KP are joint senior authors. All authors contributed to the interpretation of the data, critically revised the manuscript for important intellectual content and gave final approval for submission.

  • Funding Funding for this research was provided through a grant awarded to author Koen Pardon by The Research Foundation - Flanders (Belgium) (Fonds Wetenschappelijk Onderzoek/FWO) [G061118N].

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer-reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.