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Multicenter Study
. 2018 May;64(5):371-377.

Older patient engagement in advance care planning in Canadian primary care practices: Results of a multisite survey

Michelle Howard  1 , Carrie Bernard  2 , Doug Klein  3 , Amy Tan  4 , Marissa Slaven  5 , Doris Barwich  6 , John J You  7 , Gabriel Asselin  8 , Jessica Simon  9 , Daren K Heyland  10
Affiliations
Multicenter Study

Older patient engagement in advance care planning in Canadian primary care practices: Results of a multisite survey

Michelle Howard et al. Can Fam Physician. 2018 May.

Abstract
in English, French

Objective: To assess primary care patients' engagement in advance care planning (ACP) and predictors of engagement.

Design: Cross-sectional survey using a revised version of a validated questionnaire.

Setting: Alberta, Ontario, and British Columbia.

Participants: Convenience sample of 20 family practices that provided a consecutive sample of 810 patients aged 50 years and older.

Main outcome measures: Engagement in ACP activities, and sociodemographic and health-related predictors of having engaged in ACP activities.

Results: Patients had a mean age of 66 years (55.6% women). Two-thirds of patients (68.5%; 555) had thought about the kinds of medical treatments they would want or not want if they were sick and in hospital, 52.8% (n = 428) had talked with someone about what they would want, 32.0% (n = 259) had written down their wishes, 50.4% (n = 408) had named someone to be their substitute decision maker, and 23.0% (n = 186) had engaged in all 4 key ACP activities. Of those patients who had talked to someone about medical treatments wanted or not, 17.5% (n = 75) had talked to their family doctors. Age (adjusted odds ratio per 10-year category of 1.55; 95% CI 1.26 to 1.90; P < .001) was significantly associated with having engaged in all ACP activities.

Conclusion: Many patients have engaged in some ACP activities, but few have discussed ACP with their family physicians. Strategies should be implemented in primary care to reduce the barriers to discussing ACP.

Objectif: Vérifier à quel point les patients des soins primaires entreprennent une planification de leurs soins de fin de vie (PSFV) et déterminer les prédicteurs de cette décision.

Type d’étude: Une enquête transversale à l’aide d’une version révisée d’un questionnaire validé.

Contexte: L’Alberta, l’Ontario et la Colombie-Britannique.

Participants: Un échantillon de commodité de 20 pratiques de médecine familiale qui ont permis d’obtenir un échantillon de 810 patients âgés d’au moins 50 ans.

Principaux paramètres à l’étude: Le fait de s’impliquer dans la PSFV, et les prédicteurs sociodémographiques et de santé de l’implication dans cette activité.

Résultats: L’âge moyen des patients était de 66 ans, et 55,6 % étaient des femmes. Les deux-tiers d’entre eux (68,5 %; n =555) avaient déjà réfléchi au type de soins qu’ils voudraient ou ne voudraient pas recevoir en cas d’hospitalisation pour une maladie; 52,8 % (n = 428) en avaient discuté avec quelqu’un; 32,0 % (n = 259) avaient exprimé leurs souhaits par écrit; 50,4 % (n = 408) avaient désigné un mandataire pour prendre ces décisions; et 23,0 % (n = 186) avaient entrepris de s’occuper des 4 principaux aspects de la PSFV. Parmi les patients qui avaient parlé à quelqu’un des traitements qu’ils voulaient ou ne voulaient pas recevoir, seulement 17,5 % (n = 75) en avaient parlé à leur médecin de famille. Il y avait une association significative entre le fait d’avoir entrepris des activités dans tous les domaines de la PSFV et l’âge (rapport de cote ajusté par catégories de 10 ans d’âge de 1,55; IC à 95 % 1,26 à 1,90; P < ,001).

Conclusion: Beaucoup de patients ont commencé une certaine PSFV, mais peu en ont discuté avec leur médecin de famille. Il serait opportun d’identifier les facteurs qui font obstacle à une telle discussion en milieu de soins primaires.

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