Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians.
In dementia, advance care planning (ACP) of end-of-life issues may start as early as possible in view of the patient's decreasing ability to participate in decision making. We aimed to assess whether practicing physicians in the Netherlands and the United Kingdom who provide most of the end-of-life care, differ in finding that ACP in dementia should start at diagnosis.



In a cross-sectional study, we surveyed 188 Dutch elderly care physicians who are on the staff of nursing homes and 133 general practitioners from Northern Ireland. We compared difference by country in the outcome (perception of ACP timing), rated on a 1-5 agreement scale. Regression analyses examined whether a country difference can be explained by contrasts in demographics, presence, exposure and role perceptions.



There was wide variability in agreement with the initiation of ACP at dementia diagnosis, in particular in the UK but also in the Netherlands (60.8% agreed, 25.3% disagreed and 14.0% neither agreed, nor disagreed). Large differences in physician characteristics (Dutch physicians being more present, exposed and adopting a stronger role perception) hardly explained the modest country difference. The perception that the physician should take the initiative was independently associated with agreeing with ACP at diagnosis.



There is considerable ambiguity about initiating ACP in dementia at diagnosis among physicians practicing in two different European health care systems and caring for different patient populations. ACP strategies should accommodate not only variations in readiness to engage in ACP early among patient and families, but also among physicians.
Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Radboud university medical center, Department of Primary and Community Care, Nijmegen, The Netherlands. Electronic address: jtvandersteen@lumc.nl.
Jenny T
JT
van der Steen
School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom. Electronic address: k.galway@qub.ac.uk.
Karen
K
Galway
School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom. Electronic address: g.carter@qub.ac.uk.
Gillian
G
Carter
School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom. Electronic address: k.brazil@qub.ac.uk.
Kevin
K
Brazil
D032722:Advance Care Planning; D003430:Cross-Sectional Studies; D003704:Dementia / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013727:Terminal Care; D006113:United Kingdom
Advance care planning; Dementia; End of life; Palliative care