Improving advance care planning in general practice
Patient-centered communication is of the utmost importance in achieving good quality of care, a trusting patient-physician relationship and patient satisfaction; in particular at the end of life when cure is no longer possible and respect for patient preferences and values is pivotal to achieving a good death. Communicating delicate end-of-life topics (e.g. breaking bad news, the futility of treatment options, and end-of-life decisions) is a very difficult task. Belgium is also in a unique position since it is, together with the Netherlands and Luxemburg, the only country in the world where euthanasia is one of the legal options at the end of life. Hence, GPs are also confronted with and have to deal with life shortening wishes of their patients. In general practice, evidence-based guidelines have become essential tools to guarantee optimal quality of care. Therefore, the Bioethics Institute Ghent (UGent), the Heymans Institute (UGent), and the End-of-life Care Research Group (VUB) have developed a guideline for GPs on end of life care communication in 2003.
Recent studies have pointed out that patient-centered communication and involvement of patients in decision-making is still a very complex and demanding task. Hence, physicians feel insecure, not well-prepared and need extra guidance and training. But despite the extensive literature on the essential communication skills at the end of life, there is little evidence for the underlying assumption, i.e. that effective communication skills, as described in the literature, actually lead to improved processes and outcomes in palliative care. Inextricably bound up with this, the patients and their families too need to be well-informed about what they can and cannot expect from their physician.
The objective of this study is to identify:
- What are the experiences and expectations from patients and GPs regarding communication and the role of the GP at the end-of-life?
- What is the effect of a communication training about palliative care for GPs on the palliative process and outcomes?