Advance care planning in primary care, only for severely ill patients? A structured review.
BACKGROUND
Increasing medical possibilities, ageing of the population and the growing number of people with chronic illness appears to make advance care planning (ACP) inevitable. However, to what extent and how primary care providers (PCPs) provide ACP in daily practice is largely unknown.


OBJECTIVE
To provide an overview of the actual practice of ACP in primary care.


METHODS
We searched MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Library for empirical studies that described the practice of ACP with patients in primary health care. Studies focussing on non-adult patients, and hospital or nursing home settings were excluded.


RESULTS
Ten articles met the inclusion criteria. The content of the ACP varied from discussing to refrain from cardiopulmonary resuscitation to existential issues. The prevalence ranged from 21% of PCPs having ACP discussions with the general elderly population to 69% having ACP discussions with terminal patients and 81% with patients with mild to moderate Alzheimer's disease. ACP was more common among cancer patients than among patients with non-cancer patients. Whether health care professionals or patients initiated ACP varied greatly. Advance directives and the Gold Standard Framework were perceived as helpful to guide ACP.


CONCLUSIONS
ACP does not seem to have a systematic place in the care for all community-dwelling older people. Rather, it is used for specific groups, like patients with terminal disease, cancer and Alzheimer's Disease. Whether ACP might have beneficial effects for a broader primary care population, in terms of future care planning, is yet to be investigated.
Department of General Practice, Section of Medical Ethics, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands. j.j.glaudemans@amc.uva.nl.
Jolien J
JJ
Glaudemans
Department of General Practice, Section of Medical Ethics, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands.
Eric P
EP
Moll van Charante
Department of General Practice, Section of Medical Ethics, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands.
Dick L
DL
Willems
D000328:Adult; D032722:Advance Care Planning; D002908:Chronic Disease; D003661:Decision Support Techniques; D006801:Humans; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D012720:Severity of Illness Index
Advance care planning; Alzheimer’s disease/dementia; cancer care/oncology; chronic disease; geriatrics; palliative care/end-of-life care; primary care.