Educating Dutch General Practitioners in Dementia Advance Care Planning: A Cluster Randomized Controlled Trial |
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| Institution: | 1. Department of IQ Healthcare, Radboud University Medical Centre Nijmegen, the Netherlands;2. Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands;3. Radboudumc Alzheimer Centre, Nijmegen, the Netherlands;4. Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands;5. Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands;6. Research Group Innovating with Older Adults, Windesheim University of Applied Sciences, Zwolle, the Netherlands;7. Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands;8. Department of Geriatric Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands |
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| Abstract: | ObjectivesAdvance care planning (ACP) is seldom initiated with people with dementia (PWD) and mainly focuses on medical end-of-life decisions. We studied the effects of an educational intervention for general practitioners (GPs) aimed at initiating and optimizing ACP, with a focus on discussing medical and nonmedical preferences of future care.DesignA single-blinded cluster randomized controlled trial.Setting and participantsIn 2016, 38 Dutch GPs (all from different practices) completed the study. They recruited 140 PWD, aged ≥65 years at any stage and with any type of dementia, from their practice.MethodsIntervention group GPs were trained in ACP, including shared decision-making and role-playing exercises. Control group GPs provided usual care. The primary outcome was ACP initiation: the proportion of PWD that had at least 1 ACP conversation documented in their medical file. Key secondary outcomes were the number of medical (ie, resuscitation, hospital admission) and nonmedical (ie, activities, social contacts) preferences discussed. At the 6-month follow-up, subjects' medical records were analyzed using random effect logistics and linear models with correction for GP clustering.Results38 GP clusters (19 intervention; 19 control) included 140 PWD (intervention 73; control 67). Four PWD (2.9%) dropped out on the primary and key secondary outcomes. After 6 months, intervention group GPs initiated ACP with 35 PWD (49.3%), and control group GPs initiated ACP with 9 PWD (13.9%) odds ratio (OR) 1.99; P = .002]. Intervention group GPs discussed 0.8 more medical 95% confidence interval (CI) 0.3, 1.3; P = .003] and 1.5 more nonmedical (95% CI 0.8, 2.3; P < .001) preferences per person with dementia than control group GPs.Conclusions and ImplicationsOur educational intervention increased ACP initiation, and the number of nonmedical and medical preferences discussed. This intervention has the potential to better align future care of PWD with their preferences but because of the short follow-up, the GPs' long-term adoption remains unknown. |
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| Keywords: | Dementia general practitioners primary care advance care planning palliative care |
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