ABSTRACT
There is variation in ACP terminology and legislation of ACDs between different jurisdictions within Australia.4 General practice is the ideal setting for ACP discussions, and evidence supports patient preference for initiation of ACP while they are still healthy in the community.5-7 The Royal Australian College of General Practitioners (RACGP) recommends that general practitioners (GPs) discuss ACP as part of routine care for older patients during the annual 75 years and over health assessment.8 The COVID-19 pandemic highlighted the need for GPs to have these conversations, and there have been calls for ACP to be an integral part of pandemic health planning responses.9 Evaluating the prevalence of ACP conversations is difficult, with most studies focusing on the more tangible assessment of ACD completion. Some barriers to GPs initiating ACP include difficulties in defining the right moment to discuss the topic, a perceived lack of knowledge in the ACP process and concern regarding the potential time-consuming nature of ACP discussions.11'12 Strategies to increase initiation of ACP in general practice have focused on workshops and communication skills training for GPs and general practice nurses (GPNs), which are time and resource intensive.13-15 Some studies have shown that discussion guides and question prompt lists can improve the frequency of ACP discussions with patients, but these have been limited to palliative care settings.16-18 Most doctors believe it is their responsibility to initiate these discussions but struggle with timing.19 More evidence is needed to understand how to help GPs facilitate these conversations in a way that is acceptable and meaningful for older patients and their families. [...]it's the family that's really going to make the decision. [Female GP, FG 1.1] Some GPs preferred to focus on clinical decisions such as cardiopulmonary resuscitation (CPR) as the main subject of the conversation, while others preferred to broaden the discussion to general healthcare goals.