Advance Care Planning in Primary Care: A study on documentation of Advance Care Planning in Primary Care in The Netherlands

Abstract

Introduction Advance Care Planning is the continuous process in which patients think and talk about their point of view regarding future healthcare. It potentially improves the Quality of Life of patients in the terminal phase of life. ACP in primary care can play an important part in this process. This study aims to determine what ACP items are currently discussed in primary care in The Netherlands and what the differences in content and timing of ACP are between patients who died of cancer and patients who died of non-malignant disease. Secondly, it aims to determine what the consequences of ACP are for healthcare usage in the terminal phase of life. Methods A retrospective cohort study was performed in two GPs practices in Utrecht, The Netherlands. Content and timing of ACP was studied and compared between groups, as well as healthcare usage in the last month of life, and place of death. Results 30 patients were studied of which nineteen had cancer, and eleven had a different main diagnosis. No statistically significant difference in ACP documentation was found for main diagnosis (p = 0.071) or time in days between first ACP documentation and death (p = 0.066). Patients with ACP documentation died at home or in a hospice significantly more often than patients without ACP documentation (p = 0.035). Patients with ACP documentation at least one month before death had significantly less emergency department visits and hospital admissions than patients without ACP (p = 0.019) and more GP consultations (p = 0.006). Conclusion ACP has shown positive outcomes and may facilitate a more comfortable terminal phase of life, with less hospital usage and enabling patients to die at home or in a hospice. ACP on physical, psychosocial and spiritual domains should be applied and documented timely in primary care for all patients with a life-threatening disease. Further research needs to be done on the relation between more ACP documentation and different healthcare usage in the last month of life.