iCAN-ACP Primary Care

As part of a larger study working across different care sectors, this study will focus on using patient and health care professional tools to increase the uptake, impact, and access to advance care planning (ACP) for frail elderly Canadians in primary care. We aim to determine the impact of a interventions that include 1) identification of patients in primary care who could benefit from immediate ACP and goals of care conversations 2) a care pathway supported by a clinician conversation guide/training and patient-facing tools and decision aids designed to increase the feasibility and quality of ACP conversations and goals of care in primary care.  

To date, our program of research has focused on decision support tools for engaging and empowering patients and families in ACP and decision-making across different care settings. We have used an ‘incubator unit’ approach to beta test, evaluate and revise seven patient facing tools in primary care practices in the community across 3 provinces.  These tools have been evaluated for feasibility, acceptability and clinical sensibility in over 100 patients and evaluated prospectively for effectiveness to increase engagement in ACP in over 300 patients in primary care. We have learned that these tools are highly acceptable to patients, feasible to use and they increase knowledge and engagement in ACP behaviors among patients.  A clinician facing tool, the ‘Serious illness conversation guide’, which was developed in the U.S. is increasingly being used for clinical education in Canada. It has been tested for feasibility and effectiveness but has not yet been adapted for and evaluated in the family medicine setting in Canada. 

Using the Knowledge to Action framework, our work will aim to answer the following research questions:

1) What is the best way to identify primary care patients who could benefit from ACP conversations triggered by their family practice?  

2) Does the training and exposure to the care pathway supported by a clinician conversation guide/training and patient-facing tools and decision aids increase clinician self-efficacy for conducting ACP conversations?  

3) Does this multi-faceted intervention lead to engagement of patients and their substitute decision-maker in ACP, greater substitute decision-maker self-efficacy for future decision-making, increased concordance on understanding of values and wishes among patient, SDM and clinician? 

4) Did the intervention subsequently help with decision making and patient their experience of care in the year following the intervention? 

5) How did participating in ACP conversations with patients influence the health care provided by the primary care clinicians?

 

Principal Investigators:

Michelle Howard, PhD:  Dr. Michelle Howard is an Assistant Professor in the Department of Family Medicine and an Associate Member of the Department of Clinical Epidemiology and Biostatics at McMaster University. Dr. Howard completed her doctorate at McMaster, and her MSc at the University of Toronto. Her research interests include evaluating and improving primary care models and understanding the mechanisms and impacts of interprofessional care in primary care practices.

Robin Urquhart, PhD: Dr. Robin Urquhart is an Assistant Professor, in the Department of Surgery, with a cross-appointment in Community Health & Epidemiology, both at Dalhousie University. She is also an Affiliate Scientist with the QEII Health Sciences Centre, and a Senior Scientist at Beatrice Hunter Cancer Research Institute. She received her Interdisciplinary PhD in 2013 at Dalhousie University with a focus on how multi-level factors influence the movement of complex innovations into practice. Dr. Urquhart’s primary research interests relate to understanding and optimizing the movement of evidence-based innovations into clinical practice as well as the interface between evidence-based medicine and policy.

 

Co-Investigators:

 

Amy Tan/ Co- Investigator/ University of Calgary

Doris Barwich/ Co- Investigator/ BC Centre for Palliative Care

Douglas Klein/ Co-investigator/ University of Alberta

Marissa Slaven/ Co-Investigator/ McMaster University

Carrie Bernard/ Co-Investigator/ University of Toronto

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