Evidence map›Paper›PMID 38879532›Full record

ArticleBMC primary care2024

Clinicians' experiences implementing an advance care planning pathway in two Canadian provinces: a qualitative study.

Julie Stevens, Dawn Elston, Amy Tan, Doris Barwich, Rachel Zoe Carter, Diana Cochrane, Nicole Frenette, Michelle Howard

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC primary care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03508557 (Implementing Advance Care Planning Conversation Tools in Family Practice), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03508557 nacompletednot on this map

Implementing Advance Care Planning Conversation Tools in Family Practice

TypeinterventionalSponsorMcMaster UniversityRan2018 to 2020Enrolled80ConditionsFrail Elderly Syndrome, Chronic DiseaseArmsAdvance care planning tools
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Empowering Older Patients in Advance Care Planning: Evaluating MyCare™ as a Decision Support Tool.Health expectations : an international journal of public participation in health care and health policy · 2026
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Julie StevensEnd-of-Life Care Research Group, Vrije Universiteit Brussel, Laarkbeeklaan 103, Brussels, Belgium. julie.joseph.stevens@vub.be.
Dawn ElstonDepartment of Family Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
Amy TanDepartment of Medicine, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, Canada.
Doris BarwichDepartment of Medicine, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, Canada.
Rachel Zoe CarterDepartment of Medicine, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, Canada.
Diana CochraneBC Centre for Palliative Care, 300 - 601 Sixth St., New Westminster, BC, Canada.
Nicole FrenetteDepartment of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada.
Michelle HowardDepartment of Family Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.

Funding

Fonds Wetenschappelijk Onderzoek 11B6220N
6 · The paper itself

Abstract

backgroundAdvance care planning (ACP) is a process which enables patients to communicate wishes, values, fears, and preferences for future medical care. Despite patient interest in ACP, the frequency of discussions remains low. Barriers to ACP may be mitigated by involving non-physician clinic staff, preparing patients ahead of visits, and using tools to structure visits. An ACP care pathway incorporating these principles was implemented in longitudinal generalist outpatient care, including primary care/family medicine and general internal medicine, in two Canadian provinces. This study aims to understand clinician experiences implementing the pathway.

methodsThe pathway was implemented in one family practice in Alberta, two family practices in British Columbia (BC), and one BC internal medicine outpatient clinic. Physicians and allied health professionals delivered structured pathway visits based on the Serious Illness Conversation Guide. Twelve physicians and one social worker participated in interviews or focus groups at the end of the study period. Qualitative data were coded inductively using an iterative approach, with regular meetings between coders.

resultsClinicians described experiences with the ACP care pathway, impact at the clinician level, and impact at the patient level. Within each domain, clinicians described barriers and facilitators experienced during implementation. Clinicians also reflected candidly about potential for future implementation and the sustainability of the pathway.

conclusionsWhile the pathway was implemented slightly differently between provinces, core experiences were that implementation of the pathway, and integration with current practice, were feasible. Across settings, similar themes recurred regarding usefulness of the pathway structure and its tools, impact on clinician confidence and interactions with patients, teamwork and task delegation, compatibility with existing workflow, and patient preparation and readiness. Clinicians were supportive of ACP and of the pathway.

trial registrationThe study was prospectively registered with clinicaltrials.gov (NCT03508557). Registered April 25, 2018. https://classic. CLINICALTRIALS: gov/ct2/show/NCT03508557 .

Indexed as

Advance Care PlanningQualitative ResearchAdultAlbertaAttitude of Health PersonnelBritish ColumbiaCritical PathwaysFamily PracticeFemaleFocus GroupsHumansMaleMiddle AgedAdvance care planningFocus group studyInternal medicineInterview studyPrimary care

Identifiers

PMID38879532
PMCPMC11179357

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.