PMID- 35152892
OWN - NLM
STAT- MEDLINE
DCOM- 20220215
LR  - 20220218
IS  - 1472-684X (Electronic)
IS  - 1472-684X (Linking)
VI  - 21
IP  - 1
DP  - 2022 Feb 14
TI  - Advance care planning in primary care: a retrospective medical record study among 
      patients with different illness trajectories.
PG  - 21
LID - 10.1186/s12904-022-00907-6 [doi]
LID - 21
AB  - BACKGROUND: Advance Care Planning (ACP) enables physicians to align healthcare 
      with patients' wishes, reduces burdensome life-prolonging medical interventions, 
      and potentially improves the quality of life of patients in the last phase of 
      life. However, little objective information is available about the extent to 
      which structured ACP conversations are held in general practice. Our aim was to 
      examine the documentation of ACP for patients with cancer, organ failure and 
      multimorbidity in medical records (as a proxy for ACP application) in Dutch 
      general practice. METHODS: We chose a retrospective medical record study design 
      in seven primary care facilities. Medical records of 119 patients who died 
      non-suddenly (55 cancer, 28 organ failure and 36 multimorbidity) were analysed. 
      Other variables were: general characteristics, data on ACP documentation, 
      correspondence between medical specialist and general practitioner (GP), and 
      healthcare utilization in the last 2 years of life. RESULTS: In 65% of the 
      records, one or more ACP items were registered by the GP. Most often documented 
      were aspects regarding euthanasia (35%), the preferred place of care and death 
      (29%) and concerns and hopes towards the future (29%). Median timing of the first 
      ACP conversation was 126 days before death (inter-quartile range (IQR) 30-316). 
      ACP was more often documented in patients with cancer (84%) than in those with 
      organ failure (57%) or multimorbidity (42%) (p = 0.000). Patients with cancer had 
      the most frequent (median 3 times, IQR 2-5) and extensive (median 5 items, IQR 
      2-7) ACP consultations. CONCLUSION: Documentation of ACP items in medical records 
      by GPs is present, however limited, especially in patients with multimorbidity or 
      organ failure. We recommend more attention for - and documentation of - ACP in 
      daily practice, in order to start anticipatory conversations in time and address 
      the needs of all people living with advanced conditions in primary care.
CI  - (c) 2022. The Author(s).
FAU - Bekker, Yvonne A C
AU  - Bekker YAC
AD  - Radboud University Medical Center, Radboud Institute for Health Sciences, 
      Scientific Center for Quality of Healthcare, PO Box 9101, 6500, HB, Nijmegen, the 
      Netherlands.
FAU - Suntjens, Ankie F
AU  - Suntjens AF
AD  - Radboud University Medical Center, Radboud Institute for Health Sciences, 
      Scientific Center for Quality of Healthcare, PO Box 9101, 6500, HB, Nijmegen, the 
      Netherlands.
FAU - Engels, Y
AU  - Engels Y
AD  - Department of Anesthesiology, Radboud University Medical Center, Pain and 
      Palliative Medicine, Nijmegen, the Netherlands.
FAU - Schers, H
AU  - Schers H
AD  - Department of Primary and Community Care, Radboud University Medical Center, 
      Nijmegen, the Netherlands.
FAU - Westert, Gert P
AU  - Westert GP
AD  - Radboud University Medical Center, Radboud Institute for Health Sciences, 
      Scientific Center for Quality of Healthcare, PO Box 9101, 6500, HB, Nijmegen, the 
      Netherlands.
FAU - Groenewoud, A Stef
AU  - Groenewoud AS
AD  - Radboud University Medical Center, Radboud Institute for Health Sciences, 
      Scientific Center for Quality of Healthcare, PO Box 9101, 6500, HB, Nijmegen, the 
      Netherlands. stef.groenewoud@radboudumc.nl.
LA  - eng
PT  - Journal Article
DEP - 20220214
PL  - England
TA  - BMC Palliat Care
JT  - BMC palliative care
JID - 101088685
SB  - IM
MH  - *Advance Care Planning
MH  - Humans
MH  - Medical Records
MH  - Primary Health Care
MH  - *Quality of Life
MH  - Retrospective Studies
PMC - PMC8842525
OTO - NOTNLM
OT  - Advance care planning
OT  - End of life care
OT  - General practice
OT  - General practitioner
OT  - Medical records
OT  - Primary care
COIS- The authors declare that they have no competing interests
EDAT- 2022/02/15 06:00
MHDA- 2022/02/16 06:00
PMCR- 2022/02/14
CRDT- 2022/02/14 05:24
PHST- 2021/06/07 00:00 [received]
PHST- 2022/01/24 00:00 [accepted]
PHST- 2022/02/14 05:24 [entrez]
PHST- 2022/02/15 06:00 [pubmed]
PHST- 2022/02/16 06:00 [medline]
PHST- 2022/02/14 00:00 [pmc-release]
AID - 10.1186/s12904-022-00907-6 [pii]
AID - 907 [pii]
AID - 10.1186/s12904-022-00907-6 [doi]
PST - epublish
SO  - BMC Palliat Care. 2022 Feb 14;21(1):21. doi: 10.1186/s12904-022-00907-6.