Effectiveness of the ACA (Availability, Current issues and Anticipation) training programme on GP-patient communication in palliative care; a controlled trial

Table 4 Number and type of current and anticipated issues that the GPs addressed during the simulated 15-minute consultations in intervention group (n=62) and control group (n=64)

ACA issues	Baseline		Follow-up		Effect(difference³or odds ratio⁴) (95%confidence interval)	P-value
	Intervention n=60	Control n=64	Intervention n=55	Control n=60
All current and anticipated issues (0–13) ¹	8.00 (1.46)	7.80 (1.84)	8.05 (1.69)	7.78 (1.63)	-.07 (−.82; .69) ³	.86
Current issues (0–8) ¹	4.48 (.87)	4.58 (1.05)	4.73 (1.10)	4.52 (1.11)	.29 (−.20; .78) ³	.24
1. Diagnosis ²	43	50	42	57	.76 (.25; 2.26) ⁴	.63
2. Prognosis ²	60	55	65	53	1.23 (.45; 3.36) ⁴	.69
3. Complaints, physical ²	100	100	100	100	- ⁵	-
4. Complaints, psychosocial ²	100	98	100	98	- ⁵	-
5. Complaints, spiritual/existential ²	7	2	2	7	.06 (.001; 3.03) ⁴	.16
6. Wishes, at present ²	33	39	35	32	1.53 (.52; 4.53) ⁴	.44
7. Unfinished business ²	10	17	29	13	5.81 (1.32; 25.61) ⁴	.020
8. treatment and care options ²	95	97	100	92	- ⁵	-
Anticipated issues (0– 5) ¹	3.52 (1.20)	3.22 (1.24)	3.33 (1.17)	3.27 (1.31)	-.39 (−.98; .20) ³	.19
1. Follow-up appointments ²	93	92	100	90	- ⁵	-
2. Possible complications ²	73	72	60	70	.47 (.14; 1.63) ⁴	.23
3. Wishes, for the coming months ²	85	78	93	77	2.12 (.41; 10.94) ⁴	.37
4. The actual process of dying ²	50	48	53	50	.82 (.27; 2.45) ⁴	.72
5. End-of-life decisions ²	50	31	27	40	.13 (.03; .50) ⁴	.003

¹ Observed mean (and standard deviation) of the number of issues the GP addressed during the consultation by at least one utterance concerning an issue; interrater reliability for the ACA issues averaged 0.85 (range 0.68-0.99).
² Observed percentage of consultations in which a GP made at least one utterance concerning this issue.
³ Effect of intervention (95% confidence interval) using a linear mixed model, adjusted for baseline differences (years of experience as GP and urban versus rural/semi-rural practice location) and for possible influences of the GP’s sex, several actors simulating palliative care patients, and duration of the consultations longer than 15 minutes.
⁴ Odds ratio (95% confidence interval) using a logistic regression (generalized estimating equations=GEE) model, adjusted for baseline differences (years of experience as GP and urban versus rural/semi-rural practice location) and for possible influences of the GP’s sex, several actors simulating palliative care patients, and duration of the consultations longer than 15 minutes.
⁵ The logistic regression (GEE) model is not fit for results of binomial data close to 0 or 100% respectively.

ISSN: 2731-4553