Geriatricians’ Perception of Advance Care Planning in Acute Geriatric Units: A Qualitative Multicenter Study

Abstract

Objectives

In frail older patients, hospital readmissions often lead to medical decisions that are not aligned with the patient's values. Advance care planning (ACP) is an essential tool for personalizing care pathways, but is rarely implemented in acute geriatric units (AGUs). This study aimed to explore geriatricians’ perceptions of the feasibility of implementing ACP for patients with a high risk of mortality in AGU.

Methods

This qualitative multicenter study was conducted in 3 AGUs in northern France. Geriatricians identified patients with a high risk of mortality using the DAMAGE score and were then invited to take part in semistructured interviews, which were analyzed using an inductive thematic analysis approach, inspired by principles of grounded theory. The goal was to understand the barriers, tools, and perceptions associated with the implementation of ACPs in an acute setting.

Results

Eight geriatricians took part in the study. Of the 108 patients assessed, 59 had a high risk of mortality, but no ACP had been initiated. Three main themes emerged: (1) the hospital environment was not conducive to advance planning (lack of time, acute setting, cognitive disorders); (2) caregivers lacked training in ACP, and patients had little knowledge about ACP; and (3) there was a lack of coordination between hospital and community care providers.

Conclusions

Structural, organizational, and educational barriers limit ACP implementation in the AGU. A comprehensive approach is needed, incorporating training, institutional recognition, patient awareness, and better communication between hospitals and community care providers to encourage consistent decisions that meet older person's wishes.