Advance care planning conversations in primary care: a quality improvement project using the Serious Illness Care Program

نویسندگان

چکیده

Abstract Background Advance care planning (ACP) conversations are associated with improved end-of-life healthcare outcomes and patients want to engage in ACP their providers. Despite this, rarely occur primary settings. The objective of this study was implement through adapted Serious Illness Care Program (SICP) training sessions, understand provider (PCP) perceptions implementing into practice. Methods We conducted a quality improvement project guided by the Normalization Process Theory (NPT), an interprofessional academic family medicine group Hamilton, Ontario, Canada . NPT is explanatory model that delineates processes which organizations integrate new work. PCPs (physicians, residents, allied health providers), completed pre- post-SICP self-assessments evaluating effectiveness, survey program implementability sustainability, semi-structured qualitative interviews elaborate on barriers, facilitators, suggestions for successful implementation. Descriptive statistics pre-post differences (Wilcoxon Sign-Rank test) were used analyze surveys thematic analysis interviews. Results 30 participated SICP self-assessments, 14 NoMAD surveys, 7 interviewed. There reported improvements confidence skills. mixed opinions towards implementation, specifically concerning colleagues’ abilities conduct patients’ participate ACP. Physicians discussed busy clinical schedules, lack patient preparedness, continued discomfort or having conversations. Allied professionals difficulty sharing prognosis identification appropriate as barriers. Conclusions Training PCPs’ individual perceived abilities, but other barriers identified. Future iterations will require more systematic process support implementation regular practice, addition addressing knowledge skill gaps.

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ژورنال

عنوان ژورنال: BMC Palliative Care

سال: 2021

ISSN: ['1472-684X']

DOI: https://doi.org/10.1186/s12904-021-00817-z