B139
Leading a horse to water: challenges in end-of-life care planning for advanced cancer patients in primary care
Bruce Mason1, Kirsty Boyd1, Marilyn Kendall1, Stephen Barclay2, Liz Barker4, David Chinn5, Aziz Sheik1, Keri Thomas3, Scott Murray1
1University of Edinburgh, UK, 2University of Cambridge, UK, 3National GSF Centre, Walsall, UK, 4Marie Curie, Edinburgh, UK, 5Lynebank Hospital, Dunfermline, UK
Background
End-of-life (EoL) care initiatives recommend that the preferences of patients with advanced cancer and their families should inform future care planning. Recent national policy developments have promoted Advance Care Planning (ACP) as a key tool to help achieve this but formal ACP is little used among general practitioners. A qualitative, exploratory study was undertaken in Scotland to examine the barriers preventing GPs from undertaking ACP and develop a training intervention that could help address these.
Method
Four general practices were purposively recruited for demographics and adherence to the Gold Standards Framework. Semi-structured interviews (n=26) with GPs and nurses in these practices identified current practice and key challenges in discussing EoL care. A training workshop conducted by a palliative care specialist that introduced ACP and a toolkit was provided at each practice. After three months, the participants were re-interviewed (n=20) about their experiences of ACP and the value of the training. Transcripts of the interviews and workshops were analysed thematically.
Results
Before the intervention, clinicians showed little knowledge about ACP and operated on a planning for dying basis. Clinicians reported anxiety over the wording, content and timing of discussions about end-of-life care. EoL discussions were usually only triggered by a decline in the patients condition. The intervention prompted both GPs and nurses to initiate ACP processes in a small number of cases though they continued to express concerns about its potential for harm.
Conclusion
Recent policy initiatives to encourage ACP among general practitioners may not be well understood in practice. Clinicians face complex ideational, professional, emotional, institutional and social barriers to ACP. We suggest that the process of thinking ahead and elicitation of patient preferences needs to be reframed in terms of living well and understood in relationship to self-management and the cancer survivorship agenda.
