• Br J Gen Pract · Jun 2024

    'There's never really been an opportunity': perspectives of those with long-term conditions on advance care planning, a qualitative interview study in primary care.

    • Sonya Bushell and Fliss Murtagh.
    • University of Hull.
    • Br J Gen Pract. 2024 Jun 20; 74 (suppl 1).

    BackgroundAdvance care planning (ACP), the process of discussing and documenting people's wishes for future care, is increasingly researched within health and social care. However, it is sometimes assumed that ACP is only for those experiencing advanced cancer or those reaching the end of life. Little is known about how those living with other major conditions perceive ACP.AimTo explore attitudes towards ACP in this population.MethodIn-depth interview study in general practice.Inclusion Criteriaadults living with major conditions other than cancer (diabetes, heart disease, chronic respiratory disease, and kidney disease). Interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Thematic analysis utilised a critical realist approach, underpinned by the COM-B Behaviour Change Model. NHS ethics approval (reference: 23/PR/0078).ResultsEleven participants have been recruited (recruitment ongoing): aged 61-88 years, five males, and Rockwood Frailty Scores 1-5. Emergent COM-B themes relate to capability (wellbeing, organisational skills, and understanding); opportunity (setting, time, trust, involving others, and the 'right' moment); and motivation (motivating factors: helping loved ones, helping professionals, fearing undesirable outcomes, desiring a peaceful death, being organised, and valuing autonomy; and demotivating factors: trusting others with decisions, uncertainty regarding the future, distrusting health care, focusing on the present, and values-based objections). ACP is understood in three ways: as proactive planning, as anticipatory planning, and as acknowledgment of ill-health and mortality. Context influences understanding and understanding influences motivation. There is openness to discussing ACP as part of proactive care.ConclusionNormalising ACP before ill-health may reduce distress. Public health campaigns and preventative healthcare consultations present opportunities for ACP signposting.© British Journal of General Practice 2024.

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