Advance care planning in primary care in the East of England

• Main Author: Hayhoe, Benedict
• Published: University of East Anglia 2013
• Subjects: 362.109426
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.630115

Advance care planning (ACP) is a process of decision making enabling patients to establish healthcare preferences in advance of potential incapacity. Defined in statute in the Mental Capacity Act 2005, it continues to gain importance in the UK, with professional guidance advocating its use in primary care. This qualitative study investigated ACP in UK primary care, aiming to explore current experience, ideas and views on ACP, and establish the extent to which guidance is embedded in practice. Fifteen General Practitioners and four Old Age Psychiatrists participated in individual semi-structured interviews. Themes identified were discussed in a lay focus group, before a questionnaire survey of 142 primary care practices further tested findings. While expressing strong support for the concept, professionals displayed significant lack of knowledge about ACP and legal provisions for its use, remaining unfamiliar with guidance, and having minimal direct experience of ACP. Aware of barriers to ACP as well as potential ethical concerns, professionals acknowledged their need for training, but also stressed the importance of raising awareness of ACP amongst the general population. Feeling a need for support from other professionals in providing ACP, participants highlighted problems with availability and recognition of completed ACPs. Nevertheless, convinced of primary care’s key role in ACP, they expressed commitment to its greater use. Primary care is potentially an ideal environment to build on conceptual understanding of ACP, translating evidence, policy and guidance into practice. Despite their lack of knowledge, primary care professionals showed interest and openness to ideas regarding ACP, and were able to make relevant suggestions for improvement. These findings provide novel insight into understanding and use of ACP in primary care, with potential to form the basis for further important research as well as facilitate development of strategies to enhance implementation of patient centred ACP in this and other settings.