Actual timing versus GPs’ perceptions of optimal timing of advance care planning: a mixed-methods health record-based study

Table 2 Triggers (main categories) around the moments of the recorded actual and the perceived optimal ACP timing

	Total (n = 51)		Cancer (n = 24)		Organ failure (n = 16)		Multimorbidity (n = 11)
Timing (number of triggers identified) Triggers, % of total n identified triggers	Recorded actual (n = 144)	Perceived optimal (n = 388)*	Recorded actual (n = 71)	Perceived optimal (n = 197)*	Recorded actual (n = 41)	Perceived optimal (n = 114)*	Recorded actual (n = 32)	Perceived optimal (n = 77)*
	%	%	%	%	%	%	%	%
In timeline of the disease^a	25	28	32	39	20	23	16	9
Symptoms indicating deterioration^b	29	24	25	17	24	29	44	36
Mental and spiritual health aspects^c	24	23	25	24	22	22	25	23
Patient characteristics^d	3	3	0	2	10	4	0	7
Appropriate setting^**	10	13	10	13	10	12	9	14
Social context^e	1	2	1	1	2	3	0	4
Opportunity for initiation raised by other healthcare professional or family member	8	6	10	6	12	7	6	7

^*as perceived optimal timing of ACP initiation is identified by up to 3 GPs per health record, the total number of identified triggers is high, compared to total number of triggers of actual timing
^** constitutes period of relative wellness, a setting with adequate time, or presence of a family member
^aincludes triggers ‘Start of treatment or diagnostics’, ‘Diagnosis’, ‘After period of sickness’, ‘No curative treatment options’, ‘Suspicion of severe illness’, ‘Poor prognosis’
^bincludes triggers ‘Deterioration in chronic disease’, ‘‘Red flag’ symptoms’, ‘Functional deterioration’, ‘Acute symptoms’, ‘General deterioration’, ‘Exacerbation organ failure ‘, ‘Cognitive deterioration’, ‘Change in need for consultation’
^c includes triggers ‘Expression of patients’ reflections or wishes’, ‘Expression of patients’ or family members’ emotions’, ‘Intrinsic personality and care avoidance’
^d includes triggers ‘Extensive medical history’, ‘Age’, ‘Medication use’
^e includes triggers ‘Death or disease of family member’, ‘Social vulnerability’, ‘Change of main healthcare professional’

ISSN: 2731-4553