Implementation and quality indicators of anticipatory care planning in the primary care setting in Scotland

Kandsberger, Jacqueline (2020) Implementation and quality indicators of anticipatory care planning in the primary care setting in Scotland. PhD thesis, University of Glasgow.

Due to Embargo and/or Third Party Copyright restrictions, this thesis is not available in this service.


Anticipatory Care Planning (ACP) began as the documentation of clinical treatment preferences in Advance Directives. It has evolved into a discussion-based intervention focused on patient wishes and priorities. In Scotland, primary care is a central focus of implementation efforts. However, there are many barriers to successfully implementing ACP ranging from differentiating it from regular shared-decision making, differences between end-of-life illness trajectories, to finding appropriate means of evaluation. To progress in understanding how ACP is operationalised, this thesis addresses the following research questions: 1) What shapes the conceptual vision of ACP implementation and desired outcomes? 2) How is ACP operationalised and influenced by contextual factors? 3) To what extent do ACP process elements relate to palliative care quality indicators?
These questions are explored though the analysis of data extracted from 336 expected decedent medical records, 100 accompanying General Practitioner-completed surveys on case-specific implementation and barriers, as well as a critical analysis of the literature and of the Scottish policy framework. Insights were strengthened by drawing on Normalisation Process Theory and Boundary Object Theory, as well as through close communication with evolving local implementation efforts in the Dumfries and Galloway region, where the primary data was collected.
The electronic Key Information Summary (KIS) was found to be positively correlated with the palliative care quality indicators of home death and spending less time in hospital in the last six months of life. Having a KIS was significantly associated with patients’ understanding of their illness, their illness trajectory, and the area in which they lived. The study showed that implementation relies heavily on local and national initiatives and that there is a lack of discussions addressing potential future loss of capacity and welfare power of attorney. Flexibility in ACP documentation allows for the communication of important nuances regarding patient and family preferences and awareness. Despite promising patients and families a level platform for future-oriented end-of-life discussions, clinical care-coordination elements of ACP still take priority over future care planning. More approaches that link clinical and non-clinical elements of ACP implementation are needed for a holistic and sustainable ACP process.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Anticipatory care planning, advance care planning, acp, normalisation process theory, palliative care quality indicators.
Subjects: R Medicine > RA Public aspects of medicine
Colleges/Schools: College of Social Sciences > School of Interdisciplinary Studies
Funder's Name: Crichton Foundation (CRICFOUN)
Supervisor's Name: Clark, Professor David and White, Professor Craig
Date of Award: 2020
Embargo Date: 20 September 2022
Depositing User: Jacqueline Kandsberger
Unique ID: glathesis:2020-81648
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 22 Sep 2020 08:02
Last Modified: 22 Sep 2020 08:02

Actions (login required)

View Item View Item