Grant: CIHR Fellowship

Advance Care Planning (ACP) is recognized as an evidence-based intervention to provide high-quality care that honors patients' values, goals and preferences, via shared decision-making and long-term, trust-based relationships with healthcare professionals. However, little is known about the optimal strategies to sustain ACP use in primary care, which is critical for improving patient-relevant outcomes and health impact. This project aims to co-design and evaluate an intervention for improving the sustainability of ACP among healthcare professionals providing care to older adults with serious chronic illness in primary care. A mixed methods approach will be used. First, interviews will be conducted with knowledge users (patients, families, healthcare professionals, managers, policymakers) to identify barriers and facilitators to the sustainability of ACP and potential strategies to address them. These results will be used to co-develop a sustainability intervention, which will be refined based on knowledge users' feedback. Then, healthcare professionals from 12 primary care sites in Canada will be recruited and assigned to an intervention group or control group. Healthcare professionals' ACP use, defined as involving serious illness conversations with patients and families, and goal concordant care with patients will be assessed at baseline and 6-month follow-up, through electronic health records and self-reported surveys, respectively. Finally, a subgroup of healthcare professionals will be interviewed to explore their experiences of the intervention, factors that affect ACP use, and areas of improvements. The COVID pandemic highlighted the importance of ACP, and this research is a crucial first step in addressing the sustainability of ACP in primary healthcare services-laying the foundations for fostering patient-centered care for older adults with serious chronic illness in Canada.