Future care Advance care planning with older people and their families in general practice

In acute situations older people, family, doctors and nurses can struggle with making decisions regarding care. Consequently, older people may not receive the care they want or undergo unwanted diagnostics and treatments. With this thesis I aimed to contribute to improving such care for older people by gaining insight into the current state of advance care planning (ACP) with older people in the everyday general practice and in how this practice could be improved. Therefore we performed a literature review, qualitative interview studies and a focus group study with, amongst others, older people, family, GPs, primary care nurses, policy makers, and ethicists.
The studies in this thesis showed that all older people should have the opportunity to prepare for future decision making, regardless of the level of mental capacity or incapacity in the future. Moreover, doctors should try to have ACP with all frail older people and their families. By ‘preparing’ we mean that older people, family and GPs understand which care may or may not be in the interest of the older person in the future and which care may or may not be possible. The studies in this thesis led to the formulation of ethical conditions, practical recommendations and an information letter and a poster for older people and family, which you can find as an appendix in this thesis. Finally, we suggest a term that better fits with this decision-making process being an open conversation all older people are entitled to: future care conversations.