Randomized Control Trial of Advance Care Planning in Primary Care

In prospective and randomized trials, advance care planning (ACP) significantly improves outcomes including increased likelihood that clinicians and families understand and comply with a patient's wishes, reduces hospitalization at the end of life, results in less intensive treatments at the end of life (according to patients' wishes) and increases use of hospice services. Trials have not been done in primary care. In this project, we aim to determine the efficacy of a care pathway designed to increase the quality and quantity of ACP in patients and their substitute decision-makers in primary care. The study is a multi-site, patient-based, unblinded, randomized trial conducted in family practices in Canada. Participants will be patients who are determined by their physician to be able to benefit from ACP, and the patient's substitute decision-maker. Participant pairs will be randomized to immediate intervention (care pathway) or delayed (8-12 weeks). The intervention is guided use of tools and decision aids to clarify values and preferences for treatments in the event of serious illness or near end of life. The outcomes will be substitute decision-maker engagement in ACP (including self-efficacy for enacting the role), patient engagement in ACP, and decisional conflict.

Inclusion criteria

• Patients being treated for serious illness in outpatient settings or;
• Patients who could benefit from advance care planning self-assessed or assessed by their physician
• Patient able and willing to identify a substitute decision-maker who will participate in the study
• Patient cognitively able to participate

Exclusion criteria

• Patient or their substitute decision-maker does not speak English
• Patient unable to identify a substitute decision-maker who will consent to participation
• Patient does not consent to participation