Cues and concerns of seriously ill patients during advance care planning discussions with their GP: Presenter(s): Koen Pardon, Vrije Universiteit Brussel, Belgium. (April 2023) - Craenen, Lara
Abstract : Background: This study aims to a) explore to what extent patients with a serious illness express emotional cues and concerns during ACP conversations with their GP; b) explore the content of these cues and concerns and; c) to explore the GPs' verbal responses to these cues and concerns. Methods: A total of 20 ACP conversations were audio-recorded. Expressions of emotional cues and concerns and GPs' responses were coded using the Verona Coding Definitions of Emotional Sequences (VR-CoDES) and the Verona Codes for Provider Responses (Verona Codes-P). A qualitative directed content analysis was used to study the content of the identified cues and concerns and identify overarching themes. Findings: Expressions of emotional cues and concerns occurred in 17 of the 20 (85%) conversations. A total of 216 cues and concerns were identified (range: 1-28; median: 11). Most frequently identified were implicit expressions of cues (n = 183) rather than explicit concerns (n = 33). In 72% of responses, the GP provided space for the patient to elaborate on the expressed cues or concerns. The most common response was explicit providing space (41%) and the least common was explicit reducing space (11%). The cues and concerns were categorized into eight themes. The most common theme was "Values, norms and important aspects of quality of life". Discussion: Emotions during ACP conversations were mainly communicated implicitly as cues. The amount of cues/concerns expressed show that ACP topics can evoke emotions in patients. It is therefore important that GPs are attentive to these cues from the patients. The content of the cues/concerns also varied greatly. An important characteristic of good ACP conversations, is that discussions are tailored to the patient. GPs should thus be aware of the possible topics to discuss and provide patients the space to discuss their worries and needs regarding these topics.