OBJECTIVES Advance care planning (ACP) is seldom initiated with people with dementia (PWD) and mainly focuses on medical end-of-life decisions. We studied the effects of an educational intervention for general practitioners (GPs) aimed at initiating and optimizing ACP, with a focus on discussing medical and nonmedical preferences of future care. DESIGN A single-blinded cluster randomized controlled trial. SETTING AND PARTICIPANTS In 2016, 38 Dutch GPs (all from different practices) completed the study. They recruited 140 PWD, aged ≥65 years at any stage and with any type of dementia, from their practice. METHODS Intervention group GPs were trained in ACP, including shared decision-making and role-playing exercises. Control group GPs provided usual care. The primary outcome was ACP initiation: the proportion of PWD that had at least 1 ACP conversation documented in their medical file. Key secondary outcomes were the number of medical (ie, resuscitation, hospital admission) and nonmedical (ie, activities, social contacts) preferences discussed. At the 6-month follow-up, subjects' medical records were analyzed using random effect logistics and linear models with correction for GP clustering. RESULTS 38 GP clusters (19 intervention; 19 control) included 140 PWD (intervention 73; control 67). Four PWD (2.9%) dropped out on the primary and key secondary outcomes. After 6 months, intervention group GPs initiated ACP with 35 PWD (49.3%), and control group GPs initiated ACP with 9 PWD (13.9%) [odds ratio (OR) 1.99; P = .002]. Intervention group GPs discussed 0.8 more medical [95% confidence interval (CI) 0.3, 1.3; P = .003] and 1.5 more nonmedical (95% CI 0.8, 2.3; P < .001) preferences per person with dementia than control group GPs. CONCLUSIONS AND IMPLICATIONS Our educational intervention increased ACP initiation, and the number of nonmedical and medical preferences discussed. This intervention has the potential to better align future care of PWD with their preferences but because of the short follow-up, the GPs' long-term adoption remains unknown.

中文翻译：

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对荷兰全科医生进行痴呆症预先护理计划的教育：一项集群随机对照试验

目标 预先护理计划 (ACP) 很少针对痴呆症 (PWD) 患者发起，主要侧重于医疗临终决策。我们研究了旨在启动和优化 ACP 的全科医生 (GP) 教育干预的效果，重点讨论未来护理的医疗和非医疗偏好。设计 一项单盲整群随机对照试验。设置和参与者 2016 年，38 名荷兰全科医生（均来自不同的实践）完成了这项研究。他们从他们的实践中招募了 140 名年龄≥65 岁且处于任何阶段且患有任何类型痴呆症的 PWD。方法干预组的全科医生接受了 ACP 培训，包括共同决策和角色扮演练习。对照组全科医生提供常规护理。主要结果是 ACP 启动：在他们的医疗档案中记录了至少 1 次 ACP 对话的 PWD 的比例。关键的次要结果是讨论的医疗（即复苏、入院）和非医疗（即活动、社交接触）偏好的数量。在 6 个月的随访中，使用随机效应逻辑和线性模型分析受试者的医疗记录，并校正 GP 聚类。结果 38 个 GP 集群（19 个干预；19 个对照）包括 140 个 PWD（干预 73；对照 67）。四名 PWD (2.9%) 在主要和关键次要结果上退出。6 个月后，干预组 GP 以 35 名 PWD (49.3%) 启动 ACP，而对照组 GP 以 9 名 PWD (13.9%) 启动 ACP [优势比 (OR) 1.99；P = .002]。干预组 GP 讨论了 0.8 个以上的医疗 [95% 置信区间 (CI) 0.3, 1.3; P = .003] 和 1。每位痴呆症患者的非医疗偏好（95% CI 0.8, 2.3；P < .001）比对照组的 GP 多 5 个。结论和意义 我们的教育干预增加了 ACP 的启动，以及讨论的非医疗和医疗偏好的数量。这种干预有可能更好地使 PWD 的未来护理与他们的偏好保持一致，但由于随访时间短，GP 的长期采用仍然未知。