Researchers examined if GPs could improve the identification of patients at high risk of dying and the acceptability of providing these patients with the end-of-life planning booklet Think Ahead.
Doctors found providing the booklet was “acceptable to most patients and somewhat effective in increasing discussion among families and in practice on end-of-life issues during routine consulting.”
Lead investigator on the research Dr Brendan O’Shea said: “End-of-life planning means decision making with patients, formulating and recording decisions regarding their end-of-life care. It is regarded as challenging for doctors and patients.”
He said ascertaining patients’ end-of-life “preferences through earlier discussion with patients is likely to increase the extent that they are realised.”
Dr O’Shea who is Assistant Adjuvant Professor in Primary Care and Public Health at Trinity College Dublin said: “Patients often assume that professional carers will initiate discussions but professional carers may be hesitant. Inconsistency in recognising frailty together with low use of available end-of-life planning tools by clinicians compound challenges in understanding and acting on patient preferences.”
GPs identified patients for the research during routine consultations and invited them to take part in the study.
The 62 “frail patients” identified were aged between 64 and 69 and were each given copies of the Think Ahead form to fill out.
All 32 female patients given the booklet said they would like to see it introduced more widely. Eight out of ten of the men given the form gave it their backing.
Four GP practices in East Leinster area took part in the research. Patients at high risk of dying were identified using the Supportive and Palliative Care Indicators Tool (SPICT)
Dr O’Shea said using SPICT and Think Ahead together “appears effective in assisting GPs and patients to engage in what is a challenging and importance part of care in general practice.”
Almost half of the patients in the study had “never” discussed their end –of- life preferences with their family before they received the form.
Eight out of ten of the patients said they were “happy” to receive the form from GPs, one in ten had “no opinion” and one in ten said they were “not happy” to get the form.
Despite an overall positive response eleven of the patients found receiving the form at their GP surgery upsetting.
Topics identified as upsetting included resuscitation and ventilation. The researchers said “their level of upset needs to be set against the benefits of providing patients with a well-designed end-of-life planning tool and known harm when individuals do not have an opportunity to consider end of life.” No complaints from patients or families arose during the study.
Seven out of ten said they found no part of the form difficult to complete.
The researchers concluded: “The majority of participants in this study completed all or some of Think Ahead. Despite known concerns of GPs about raising end-of-life preferences, most participants were not upset by Think Ahead, while many found it useful and indicated that Think Ahead should be distributed more widely.”
Think Ahead was devised by the Irish Hospice Foundation’s Forum on End of Life in Ireland . There are now more than 50,000 copies of the document in circulation throughout the country.
The form allows people to put their end-of-life preferences down in writing including people to contact in the event of an emergency, health insurance information, healthcare preferences, their cultural and religious beliefs.
Think Ahead has a section too for an Advance Healthcare Directive which informs family, friends and doctors of a patient’s wishes for your treatment in the event you can no longer communicate them yourself.
For example patients can indicate the treatment they wouldn’t like to receive for example cardiopulmonary resuscitation (CPR) or life sustaining treatments like being placed on a breathing machine.
The study is entitled End-of-Life planning with frail patients attending general practice: an exploratory prospective cross-sectional study.
The researchers are: Eoin J Dunnphy, Sarah C Conlon, Sarah O’Brien, Emer Loughrey and Brendan O’Shea.
Further information on Think Ahead can be found at www.thinkahead.ie
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