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Abstract：
BACKGROUND: General practice is often recommended as an ideal setting to initiate advance care planning (ACP), but uptake of ACP in this setting is low. ACP-GP is a complex intervention to facilitate ACP for patients with chronic, life-limiting illness in Belgian general practice. It aims to increase patient ACP engagement and general practitioner (GP) ACP self-efficacy. In a cluster-randomized controlled trial, the intervention was not superior to control in increasing these outcomes. A parallel process evaluation aimed to enhance understanding of how the intervention was implemented, and which factors might have influenced trial results.
METHODS: We conducted a mixed-methods process evaluation following the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources include recruitment and implementation monitoring, questionnaires for patients and GPs, and semi-structured (focus group) interviews with patients and GPs. Questionnaire data were analyzed descriptively. Qualitative data were first analyzed inductively; themes were then assigned deductively to RE-AIM dimensions.
RESULTS: Thirty-five GPs and 95 patients were recruited to the trial; GP reach was low. Sixteen GPs and 46 patients provided questionnaire data at 3 months post-baseline; qualitative data were transcribed for 14 GPs and 11 patients. Adoption of intervention components was moderate to good, with the exception of the documentation template for GPs. Interviews revealed varying patient attitudes towards ACP, but patients nonetheless emphasized that conversations made them feel reassured. GPs especially valued a positive framing of ACP. When adopted, the intervention was well-implemented and participant satisfaction was high. However, intention for maintenance was moderate, with GPs raising questions of how to sustainably implement ACP conversations in the future.
CONCLUSIONS: Implementing the complex ACP-GP intervention in general practice is feasible, and can be successful. However, the implementation process is challenging and the sustainability is suboptimal. Our findings will guide future research and recommendations for facilitating and implementing ACP in general practice.
BACKGROUND: ISRCTN12995230; prospectively registered on 19/06/2020.
METHODS: We conducted a mixed-methods process evaluation following the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources include recruitment and implementation monitoring, questionnaires for patients and GPs, and semi-structured (focus group) interviews with patients and GPs. Questionnaire data were analyzed descriptively. Qualitative data were first analyzed inductively; themes were then assigned deductively to RE-AIM dimensions.
RESULTS: Thirty-five GPs and 95 patients were recruited to the trial; GP reach was low. Sixteen GPs and 46 patients provided questionnaire data at 3 months post-baseline; qualitative data were transcribed for 14 GPs and 11 patients. Adoption of intervention components was moderate to good, with the exception of the documentation template for GPs. Interviews revealed varying patient attitudes towards ACP, but patients nonetheless emphasized that conversations made them feel reassured. GPs especially valued a positive framing of ACP. When adopted, the intervention was well-implemented and participant satisfaction was high. However, intention for maintenance was moderate, with GPs raising questions of how to sustainably implement ACP conversations in the future.
CONCLUSIONS: Implementing the complex ACP-GP intervention in general practice is feasible, and can be successful. However, the implementation process is challenging and the sustainability is suboptimal. Our findings will guide future research and recommendations for facilitating and implementing ACP in general practice.
BACKGROUND: ISRCTN12995230; prospectively registered on 19/06/2020.
摘要：
背景：通常建议将一般实践作为启动预先护理计划（ACP）的理想设置，但这种情况下ACP的摄取量较低。ACP-GP是一种复杂的干预措施，以促进慢性患者的ACP，比利时全科医生的限制生命的疾病。旨在提高患者ACP参与度和全科医生（GP）ACP自我效能。在一项集群随机对照试验中，在增加这些结局方面,干预并不优于对照组.并行过程评估旨在增强对干预措施实施方式的理解，以及哪些因素可能影响了试验结果。
方法：我们进行了混合方法过程评估，有效性,收养,实施,维护(RE-AIM)框架。数据来源包括征聘和执行监测，针对患者和全科医生的问卷，以及对患者和全科医生的半结构化（焦点小组）访谈。问卷数据进行描述性分析。首先对定性数据进行归纳分析；然后将主题演绎地分配给RE-AIM维度。
结果：招募了35名全科医生和95名患者参加试验；全科医生的覆盖率很低。16名全科医生和46名患者在基线后3个月提供了问卷数据；转录了14名全科医生和11名患者的定性数据。采用干预成分是中度到良好的，GP的文档模板除外。访谈显示患者对ACP的态度各不相同，但是患者仍然强调，谈话使他们感到放心。全科医生特别重视ACP的积极框架。通过时，干预措施实施良好,参与者满意度高.然而,维护意向适中，全科医生提出了如何在未来可持续地实施ACP对话的问题。
结论：在一般实践中实施复杂的ACP-GP干预是可行的，并且可以成功。然而,实施过程具有挑战性，可持续性次优。我们的研究结果将指导未来的研究和建议，以促进和实施ACP在一般实践中。
背景：ISRCTN12995230；预期于2020年6月19日注册。
方法：我们进行了混合方法过程评估，有效性,收养,实施,维护(RE-AIM)框架。数据来源包括征聘和执行监测，针对患者和全科医生的问卷，以及对患者和全科医生的半结构化（焦点小组）访谈。问卷数据进行描述性分析。首先对定性数据进行归纳分析；然后将主题演绎地分配给RE-AIM维度。
结果：招募了35名全科医生和95名患者参加试验；全科医生的覆盖率很低。16名全科医生和46名患者在基线后3个月提供了问卷数据；转录了14名全科医生和11名患者的定性数据。采用干预成分是中度到良好的，GP的文档模板除外。访谈显示患者对ACP的态度各不相同，但是患者仍然强调，谈话使他们感到放心。全科医生特别重视ACP的积极框架。通过时，干预措施实施良好,参与者满意度高.然而,维护意向适中，全科医生提出了如何在未来可持续地实施ACP对话的问题。
结论：在一般实践中实施复杂的ACP-GP干预是可行的，并且可以成功。然而,实施过程具有挑战性，可持续性次优。我们的研究结果将指导未来的研究和建议，以促进和实施ACP在一般实践中。
背景：ISRCTN12995230；预期于2020年6月19日注册。
