Preparing Older Patients With Serious Illness for Advance Care Planning Discussions in Primary Care

Abstract

Context: Little is known about how to prepare older patients for advance care planning (ACP) discussions in primary care.

Objectives: The objective of the study was to explore older patients' perspectives and experiences on ACP discussions with family members and/or primary care clinicians.

Methods: We conducted a qualitative interview study with 20 older patients who were involved in the clinic's ACP quality improvement initiative. We used an inductive approach to generate a coding scheme and used thematic analysis alongside a constant comparative methodology to iteratively refine emergent themes after coding the data. We used the transtheoretical behavior change model to conceptualize the process of ACP discussions, focusing on the contemplation, preparation, and action stages.

Results: Four key themes emerged from our analyses: 1) the relevance/importance of ACP as a whole; 2) independently conceptualizing wishes and preferences for the future; 3) the process of engagement in ACP discussions; and 4) different outcomes of ACP discussions. While patients contemplated having an ACP discussion, they needed time to conceptualize their wishes on their own before documenting wishes or engaging with others. Moving to the preparation stage, patients shared their perspectives about how to engage family members and primary care clinicians in ACP discussions and reported different outcomes of these discussions, which varied according to patients' goals for ACP.

Conclusion: Understanding how to best prepare patients for ACP discussions from patients enrolled in an ACP primary clinic quality improvement initiative may assist primary care practices in developing interventions to improve the occurrence and effectiveness of such discussions.

Keywords: Advance care planning; advance care planning discussions; advance directives; patient-centered communication; primary care; qualitative research.