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Title: Implementation and quality indicators of anticipatory care planning in the primary care setting in Scotland
Author: Kandsberger, Jacqueline
ISNI:       0000 0004 9356 3530
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 2020
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Anticipatory Care Planning (ACP) began as the documentation of clinical treatment preferences in Advance Directives. It has evolved into a discussion-based intervention focused on patient wishes and priorities. In Scotland, primary care is a central focus of implementation efforts. However, there are many barriers to successfully implementing ACP ranging from differentiating it from regular shared-decision making, differences between end-of-life illness trajectories, to finding appropriate means of evaluation. To progress in understanding how ACP is operationalised, this thesis addresses the following research questions: 1) What shapes the conceptual vision of ACP implementation and desired outcomes? 2) How is ACP operationalised and influenced by contextual factors? 3) To what extent do ACP process elements relate to palliative care quality indicators? These questions are explored though the analysis of data extracted from 336 expected decedent medical records, 100 accompanying General Practitioner-completed surveys on case-specific implementation and barriers, as well as a critical analysis of the literature and of the Scottish policy framework. Insights were strengthened by drawing on Normalisation Process Theory and Boundary Object Theory, as well as through close communication with evolving local implementation efforts in the Dumfries and Galloway region, where the primary data was collected. The electronic Key Information Summary (KIS) was found to be positively correlated with the palliative care quality indicators of home death and spending less time in hospital in the last six months of life. Having a KIS was significantly associated with patients’ understanding of their illness, their illness trajectory, and the area in which they lived. The study showed that implementation relies heavily on local and national initiatives and that there is a lack of discussions addressing potential future loss of capacity and welfare power of attorney. Flexibility in ACP documentation allows for the communication of important nuances regarding patient and family preferences and awareness. Despite promising patients and families a level platform for future-oriented end-of-life discussions, clinical care-coordination elements of ACP still take priority over future care planning. More approaches that link clinical and non-clinical elements of ACP implementation are needed for a holistic and sustainable ACP process.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA Public aspects of medicine