title: Development of a complex intervention to support the initiation of advance care planning by general practitioners in patients at risk of deteriorating or dying: a phase 0-1 study.
abstract: BACKGROUND
  Most patients with life-limiting illnesses are treated and cared for over a long period of time in primary care and guidelines suggest that ACP discussions should be initiated in primary care. However, a practical model to implement ACP in general practice is lacking. Therefore, the objective of this study is to develop an intervention to support the initiation of ACP in general practice.
  
  
  METHODS
  We conducted a Phase 0-I study according to the Medical Research Council (MRC) Framework. Phase 0 consisted of a systematic literature review about the barriers and facilitators for GPs to engage in ACP, focus groups with GPs were held about their experiences, attitudes and concerns regarding initiating ACP in general practice and a review of ACP interventions to identify potential components for the development of our intervention. In Phase 1, we developed a complex intervention to support the initiation of ACP in general practice in patients at risk of deteriorating or dying, based on the results of Phase 0. The complex intervention and its components were reviewed and refined by two expert panels.
  
  
  RESULTS
  Phase 0 resulted in the identification of the factors inhibiting or enabling GPs' initiation of ACP and important components underpinning existing ACP interventions. Based on these findings, an intervention was developed in Phase 1 consisting of: (1) a training for GPs in initiating and conducting ACP discussions, (2) a register of patients eligible for ACP discussions, (3) an educational booklet on ACP for patients to prepare the ACP discussions that includes general information on ACP, a section on the role of GPs in the process of ACP and a prompt list, (4) a conversation guide to support GPs in the ACP discussions and (5) a structured documentation template to record the outcomes of discussions.
  
  
  CONCLUSIONS
  Taking into account the barriers and facilitators for GPs to initiate ACP as well as the key factors underpinning successful ACP intervention in other health care settings, a complex intervention for general practice was developed, after gaining feedback from two expert panels. The feasibility and acceptability of the intervention will subsequently be tested in a Phase II study.
authors: End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium. adevlemi@vub.ac.be.
authors: Aline
authors: A
authors: De Vleminck
authors: End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium.
authors: Dirk
authors: D
authors: Houttekier
authors: End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium.|Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
authors: Luc
authors: L
authors: Deliens
authors: End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium.|Heymans Institute, Ghent University, Ghent, Belgium.
authors: Robert
authors: R
authors: Vander Stichele
authors: End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Jette, Belgium.|Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
authors: Koen
authors: K
authors: Pardon
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000706:statistics & numerical data*; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D061345:Early Medical Intervention / Q000379:methods* / Q000706:statistics & numerical data; D017144:Focus Groups; D058005:General Practitioners; D006801:Humans; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods* / Q000592:standards*; D018570:Risk Assessment