Anticipating emotion: a qualitative study of advanced care planning in the community setting

Advance care planning at the end of life is high on the political agenda
across the UK. The aim is to deliver patient-centred care for all
patients, whenever possible in their preferred place of care. It is widely
acknowledged that discussions about the end of life are sensitive and
often difficult for health professionals, particularly those in the
community setting. The aim of this qualitative study was to determine
the factors that assist or hinder the primary care health professionals
having these discussions. The sample included one GP and one district
nurse (DN) from each of three GP practices. Semi-structured
interviews were conducted with the participants, and the data was
analysed using a thematic approach. The findings clearly depict two of
the challenges faced by the GPs and DNs in the community: emotional
labour, and balancing patients’ and families’ expectations about care
provision in the community with the limited resources available. This
study contributes to the knowledge base of advance care planning by
providing insight into the experiences of the GPs and DNs who care
for patients at the end of life. Further research is required to more
fully understand the emotional impact on the health professionals
having these sensitive discussions.
Key words: Advanced care planning