title: Advance care planning for cancer patients in primary care: a feasibility study.
abstract: BACKGROUND
  Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging.
  
  
  OBJECTIVE
  To assess the feasibility of implementing advance care planning in UK primary care.
  
  
  METHODS
  Mixed methods evaluation of a pilot educational intervention.
  
  
  METHODS
  Four general practices in south-east Scotland.
  
  
  METHODS
  Interviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK.
  
  
  RESULTS
  End-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a 'good death'. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of 'tick-box' approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care.
  
  
  CONCLUSIONS
  A clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes.
authors.affiliation: Primary Palliative Care Research Group, Edinburgh. kirsty.boyd@ed.ac.uk
authors.forename: Kirsty
authors.initials: K
authors.lastname: Boyd
authors.forename: Bruce
authors.initials: B
authors.lastname: Mason
authors.forename: Marilyn
authors.initials: M
authors.lastname: Kendall
authors.forename: Stephen
authors.initials: S
authors.lastname: Barclay
authors.forename: David
authors.initials: D
authors.lastname: Chinn
authors.forename: Keri
authors.initials: K
authors.lastname: Thomas
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.forename: Scott A
authors.initials: SA
authors.lastname: Murray
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D005240:Feasibility Studies; D058006:General Practice / Q000193:education*; D006801:Humans; D013727:Terminal Care / Q000458:organization & administration* / Q000523:psychology