Grant: Partnerships for Health System Improvement (PHSI)

Our population is aging and more people are living with advanced chronic diseases. At the end of life (EOL), this presents multiple challenges to our health care system. The use of aggressive medical treatments in hospitals at the EOL is increasing and is actually associated with worse outcomes. The patient suffers lower quality of life in the final days, the family suffers from guilt and regret in the months that follow, health care professionals suffer distress that the wrong care was provided to a dying patient, and limited health care resources are spent unnecessarily. Advance Care Planning (ACP) may offer some assistance with improving quality of care at the EOL and reduce health care costs. ACP is a process wherein people think about the various options related to future health care decisions and they may come up with a verbal or written plan of what care they would want (or not want) at the EOL. Further, they nominate a substitute decision maker if they become unable to speak for themselves. ACP has been shown to increase the quality of life of dying patients, improve the experience of family and health care professionals, and decrease health care costs. Yet a national poll commissioned by our group demonstrated that few Canadians have thought about or made an ACP. ACP should ideally be done in primary care where patients can talk with their usual doctor while they are not acutely ill. Thus, the purpose of this project is to increase ACP in primary care. Our main research question is: How do we get Canadians doing ACP in primary care settings? We will partner with 10 primary care settings in Ontario that will help us develop, evaluate and implement ACP tools and strategies. In addition, we will be building a network of stakeholders interested in ACP in primary care and will hold meetings to share our findings. By increasing the quality and quantity of ACP in primary care, we can make improvements in quality of EOL care and reduce overall health costs.