Information meetings on end-of-life care for older people by the general practitioner to stimulate advance care planning: a pre-post evaluation study

Abstract

Background: To increase knowledge about options people have concerning end-of-life-care issues, General Practitioners (GPs) can organise meetings to inform their older patients. We evaluated these meetings, using the following research questions: How did the attendees experience the information meeting? Was there a rise in Advance Care Planning (ACP) behaviour after the information meeting? Was there a change in trust people have that physicians will provide good care at the end of life and that they will follow their end-of-life wishes after the information meetings?

Methods: Four GPs invited all patients of 75 years and older registered in their GP practices to the meeting via a written letter. Four meetings of 2 h took place in 2016. Meetings started with a presentation on end-of-life topics and ACP by the GP followed by time for questions. A pre-post evaluation study was done using written questionnaires distributed and filled in at the start of the meeting (T₀) at the end of the meeting (T₁) and 6 months after the meeting (T₂).

Results: In total 225 older people attended a meeting of which 154 (68%) filled in the questionnaire at T₀ and 145 (64%) filled in the questionnaire at T₁. After six months, 90 of the 121 people who approved of being sent another questionnaire at T₂, returned it (40%). The average age of the respondents was 80 years (T₀). The meetings were evaluated positively by the attendees (T₁). ACP issues (appointing a proxy, resuscitation, hospitalisation, euthanasia, treatment preferences under certain circumstances, preferred place of care and nursing home admittance) were discussed with a physician, a relative or both more often in the 6 months after having attended the meeting (T₂), compared to before (T₀). Compared to before the meeting (T₀), trust in the GP providing good end-of-life care and following end-of-life wishes was higher immediately after the meeting (T1), but not after 6 months (T₂).

Conclusion: Information meetings on end-of-life care by GPs have a positive influence on the occurrence of ACP, both with the physician and others. Although, this method especially reaches the older people that are already interested in the subject, this seems a relatively easy way to stimulate ACP.

Keywords: Advance care planning; Advance directives; Communication; General practice; Health services for the aged; Physician–patient relations.

Fig. 1

Plans to have a conversation with their physicians and execution of plans 6 months later¹. ¹Selection of attendees who filled in T₁ and T₂ (n = 86). Missing data: n = 21

Fig. 2

Plans to have a conversation with others and execution of plans 6 months later. Selection of attendees who filled in T₁ and T₂ (n = 86). Missing data: n = 14

Fig. 3

Plans to write wishes down and execution of that plan 6 months later. Selection of attendees who filled in T₁ and T₂ (n = 86). Missing data: n = 21