The views of general practitioners on advance care planning for patients living with dementia

Background Advance care planning (ACP) facilitates communication<br/>and understanding of preferences, nevertheless the use of<br/>ACPs in primary care for patients with dementia is low. The disease’s<br/>uncertain course and the inability to communicate with<br/>the patient living with dementia are significant challenges for<br/>GPs.<br/>Aim The purpose of this study was to describe the attitudes and<br/>practice preferences of GPs working within the UK’s National<br/>Health System (NHS) regarding communication, and decisionmaking<br/>for patients with dementia and their families<br/>Methods A cross-sectional survey, using a purposive, cluster sample<br/>of GPs across Northern Ireland with registered dementia<br/>patients was used.<br/>Results One hundred and thirty-three GPs (40.6%) participated<br/>in the survey, representing 60.9% of surveyed practices. While<br/>most respondents regarded dementia as a terminal disease<br/>(96.2%) only 37.6% felt that palliative care applied equally from<br/>the time of diagnosis to severe dementia. While most respondents<br/>thought that early discussions would facilitate decision-making<br/>during advanced dementia (61%), respondents were divided<br/>on whether ACP should be initiated at the time of diagnoses<br/>(39.8% in favour vs 45.8% disagreed). Interestingly, GPs who<br/>were longer in practice placed greater importance on the presence<br/>of an advance directive (F (2, 124) = 3.38, p = 0.037).<br/>Discussion The timing of initiating ACP varies across individuals<br/>requiring GPs to carefully consider strategies and receptiveness<br/>of the patient and family carer.<br/>Conclusion The findings promote both ongoing training in communication<br/>and dementia management for GPs to meet the<br/>needs of their patients living with dementia.