Many older patients with serious illness want to maintain quality of life rather than prolong it. However, wishes about medical treatment preferences are often unknown or unheeded resulting in unwanted or non-beneficial invasive treatments during the last days of life.
The iCAN-ACP study, funded by the Canadian Frailty Network, is a 3-year national study that aims to improve this situation by introducing and evaluating advance care planning tools that we hope will result in more, earlier and better conversations between older adults, families and the health care team. Advance care planning involves thinking about and communicating your preferences for care in a way that expresses your values. It also includes choosing someone to be your Substitute Decision Maker, someone who could speak for you and honour your wishes if you can’t speak for yourself.
The iCAN-ACP study is being conducted in family doctor’s offices in Alberta, British Columbia and Ontario. Building on the longstanding relationships between patients and their family physician, which can facilitate advance care planning (ACP) discussions, the primary care working group is examining a pathway supported by the Serious Illness Conversation Guide (SICG) www.ariadnelabs.org, patient-facing ACP tools and participation of allied health professionals, to improve ACP conversations in family medicine.
In this study, patients over age 60 with serious health conditions and their substitute decision-maker are invited to two ACP appointments. The first is with a nurse or social worker for ACP orientation and to begin the serious illness conversation, complete a values clarification tool, and share the information with the physician. The second visit is with the physician, using the SICG to discuss the patient’s specific health issues and illness trajectory, followed by completion of appropriate provincial documents.
We are evaluating patients’ ACP engagement using a validated survey before and after the process. Outcome measures include changes in confidence and readiness to undertake specific ACP behaviours. We are also evaluating the patients’ experience with the conversations in family practice (e.g. changes in illness understanding, feeling of control over medical decisions, sense of peacefulness).
We expect that a step-wise pathway incorporating the SICG and a values clarification tool, and supported by allied health professionals will increase patients’ engagement in ACP in family medicine practices, improving the quality their experiences and outcomes.
John You, MD, MSc, FRCPC — McMaster University (Project Leader)
Michelle Howard, PhD, MSc — McMaster University (Deputy Project Leader)
Doris Barwich, MD, CCFP — University of British Columbia
Gloria Gutman, PhD, FCAHS, OBC, LLD(Hon.) — Simon Fraser University
Dev Jayaraman, MD, MPH – McGill University
Sharon Kaasalainen, RN, BScN, MSc, PhD — McMaster University
Daniel Kobewka, MD FRCPC MSc — University of Ottawa
Jessica Simon, MBChB, FRCPC — University of Calgary
Amy Tan, MD, MSc, CCFP(PC), FCFP — University of Calgary
Tamara Sussman, MSW, PhD — McGill University
Robin Urquhart, PhD — Dalhousie University
- Dundas Family Medical Group (ON)
- Queen Square Family Health Team (ON)
- New Westminster Family Practice (BC)
- Sunridge Family Medicine Teaching Centre (AB)
- B.C. Centre for Palliative Care (BC)