Advance Care Planning in Primary Care: A Step toward Normalizing the Conversation

Shannon L Roberts; Susan Joyce; Anita Greig; Fereshte Nurdin Lalani; Liad Salz; Gili Rosen; Rosanna Macri

doi:10.12927/hcq.2023.27215

Advance Care Planning in Primary Care: A Step toward Normalizing the Conversation

Healthc Q. 2023 Oct;26(3):43-52. doi: 10.12927/hcq.2023.27215.

Authors

Shannon L Roberts¹, Susan Joyce², Anita Greig³, Fereshte Nurdin Lalani⁴, Liad Salz⁵, Gili Rosen⁶, Rosanna Macri⁷

Affiliations

¹ Is a doctoral student at the Institute of Health Policy, Management and Evaluation and the Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, and a project-specific bioethics research volunteer student at Hennick Bridgepoint Hospital, Sinai Health, in Toronto, ON.
² Is a retired family physician and general practitioner psychotherapist at Wilson Medical Group and adjunct lecturer in the Department of Family and Community Medicine at the University of Toronto in Toronto, ON.
³ Is a family physician at Wilson Medical Group and assistant professor in the Department of Family and Community Medicine at the University of Toronto in Toronto, ON.
⁴ Is a family physician at Wilson Medical Group and an adjunct lecturer in the Department of Family and Community Medicine at the University of Toronto in Toronto, ON.
⁵ Is a community family physician at Wilson Medical Group, an obstetrical care provider at Sunnybrook Health Sciences Centre and a lecturer in the Department of Family and Community Medicine at the University of Toronto in Toronto, ON.
⁶ Is a family physician at Wilson Medical Group, a lecturer in the Department of Family and Community Medicine at the University of Toronto and the medical director at Baycrest Terraces, Baycrest Geriatric Centre, in Toronto, ON.
⁷ Is a bioethicist with Sinai Health, a member of the Joint Centre for Bioethics and a lecturer in the Dalla Lana School of Public Health and the Department of Radiation Oncology at the University of Toronto in Toronto, ON.

PMID: 38018788
DOI: 10.12927/hcq.2023.27215

Abstract

Despite the number of advance care planning (ACP) conversation guides and tools, ACP conversations are not common in healthcare. In this quality improvement project, we took a different approach and applied complex adaptive systems theory to develop an intervention that emerged from the users (family physicians) themselves - a standardized e-form with prompts. By listening to the users, we were able to integrate ACP best practices, including shifting the focus of ACP conversations from treatment decisions to patient values, in a way that met both users' and patients' needs, addressed barriers and will help normalize ACP conversations in primary care. The intervention was designed for any patient and family physician and may have utility for other family practice groups.

MeSH terms

Advance Care Planning*
Communication
Humans
Primary Health Care