New study studies best approach to advance care planning in primary care

Feb 18, 2020
Talking to our loved ones who are seriously ill about what they prefer and wish for with their care can be daunting. If these conversations do not happen, however, patients can end up with tests and treatments that they do not want or that are not consistent with their goals or values. A new international study is aiming to help avoid this scenario by examining how advance care planning can be facilitated in primary care practices for patients suffering from serious illnesses.

“Family doctors are well-positioned to provide advance care planning,” says University of Toronto Practice-Based Research Network (UTOPIAN) Director and University of Toronto Department of Family and Community Medicine (DFCM) faculty member, Dr. Michelle Greiver. “The long-standing relationships that develop between patients and their family doctors put family doctors in a trusted position to engage in these important conversations with their patients about their goals, values, and personal preferences for care.”

But what is the best approach to initiating these conversations and conducting advance care planning in primary care?

UTOPIAN is one of seven Practice-Based Research Networks (PBRNs) and one of two Canadian networks that are part of a consortium, the Meta-Network Learning Research Centre (Meta-LARC), that are participating in a large international study that aims to tackle this question.

The study, funded by the Patient-Centered Outcomes Research Institute® (PCORI®), focuses on comparing two models of the Serious Illness Care Program (SICP) – which gives clinicians language to talk to patients with serious illnesses - to help understand how family doctors and other primary care works can lead advance care planning. The two models that are being compared are:

  • The clinician-focused SICP model, where a patient’s primary care provider is responsible for initiating and conducting these sensitive conversations with patients and their families about advance care planning and;
  • The team-based SICP model, wherein the tasks in advance care planning are shared among members of a patient’s primary care team.

Each PBRN has recruited five or six health teams to participate in the study. The teams are then randomly assigned to one of the two models, and receive both online and in-person training. After completing the training, each practice is implementing advance care planning and recruiting patients they think will benefit from participating in this study.

UTOPIAN  has recruited Women’s College Hospital Family Health Team, St. Michael’s Family Health Team, North York Family Health Team, a community health centre, and the Guelph Family Health Team to participate. All teams have completed their training.

“I strongly believe that preparing patients for what lies ahead is vital to ensuring that they maintain dignity, autonomy, and quality of life as they navigate their illnesses and old age,” says Dr. Dahlia Balaban, a family doctor at North York General Hospital who has undergone the training. “After going through the training sessions, my comfort with having these discussions has increased, and I feel confident that my patients will benefit from having a provider who is equipped to help them through the advanced planning process.”

Recruitment of patients has begun and is expected to be completed by June 2020. The patients will then be followed over the course of the following year, and surveys will be conducted three times throughout that period.