Advance Care Planning (ACP) is crucial for individuals, especially those with dementia, to articulate their preferences for future medical care. General Practitioners (GPs), due to their enduring relationships with patients, are ideally positioned to initiate ACP. However, ACP implementation for dementia patients in primary care remains infrequent. While prior research has identified various obstacles and enablers, gaps in understanding persist. This article delves into the barriers and facilitators of ACP for community-dwelling individuals with dementia, emphasizing the role of holistic diagnosis in this process.
Building Trust Through Holistic Assessment
A foundational element for successful ACP is the establishment of a strong, trust-based relationship between the GP, the person with dementia, and their family caregiver. This therapeutic alliance is significantly enhanced by a holistic diagnostic approach. Holistic diagnosis, in this context, extends beyond the clinical identification of dementia. It encompasses understanding the patient’s broader life situation, values, and preferences from the outset. Home visits, as highlighted in the original research, provide a valuable setting for GPs to conduct this holistic assessment, fostering a more comfortable and personal environment conducive to building trust. By considering not just the medical aspects but also the social, emotional, and practical challenges faced by the patient and their family, GPs can create a more robust foundation for open and honest conversations about future care.
Characteristics of Effective ACP Conversations in Holistic Care
The nature of ACP conversations is significantly shaped by a holistic diagnostic approach. Effective conversations move beyond purely medical discussions to incorporate non-medical aspects of the patient’s life early in the diagnostic process. This includes understanding their personal values, life goals, fears, and preferences regarding their care journey. By adopting a holistic perspective, GPs can tailor ACP discussions to be more person-centered, addressing what truly matters to the individual with dementia and their family. This ensures that ACP becomes a meaningful and relevant process, rather than a mere formality. A holistic understanding allows for proactive anticipation of potential future needs and concerns, enabling more timely and effective ACP conversations.
Overcoming Primary Care Setting Barriers Through Integrated Holistic Practice
Despite the recognized importance of ACP, primary care settings often present barriers to its consistent implementation. Time constraints faced by GPs are a significant obstacle. Furthermore, concerns about the practicalities of documenting ACP outcomes and ensuring accessibility for other healthcare providers also hinder the process. However, a commitment to holistic diagnosis can contribute to overcoming these challenges. By integrating ACP as a natural extension of a holistic approach to dementia care, it can become a more streamlined and efficient process. Exploring the delegation of certain ACP tasks to practice nurses or case managers, as suggested by the research, aligns with a holistic model of care delivery. This collaborative approach can alleviate GP workload and ensure that ACP is proactively offered and facilitated for all dementia patients within primary care.
Conclusion: Holistic Diagnosis as the Cornerstone of Advance Care Planning in Dementia
In conclusion, successful Advance Care Planning for community-dwelling individuals with dementia is significantly facilitated by a holistic approach to diagnosis and care within primary care settings. Building a trust-based relationship, addressing both medical and non-medical concerns in ACP conversations, and strategically adapting primary care practices are crucial elements. While GP time limitations and documentation concerns remain challenges, integrating ACP into a broader holistic framework and exploring task-sharing with other healthcare professionals offer promising pathways to enhance ACP implementation and improve the quality of care for individuals living with dementia and their families.
