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Technology and health care for the elderly medical research studies

Focus on strategic priorities that have significant social impact.

CORE 2013-13

iGAP‐ Improving General Practice Advance Care Planning

The purpose of this project is to increase advance care planning (ACP) in primary care.

Possible Research Results

Anticipated findingsBy engaging with primary care health teams and their patients, we will create new knowledge about how to optimize ACP in primary care settings that may be generalizable to other primary care practice settings. Given that there are provincial differences in the legal/ethical framework for ACP, we will enhance the likelihood that our findings will be generalizable by working in multiple provinces, and we will be able to specify when the findings are specific to provincial settings.

Impact of findingsImplementing ACP in family practice with the doctor and health care team who are the primary medical “home” for the patient could capitalize on these existing relationships. This is important since if it does not happen in primary care, it will be too late as often frail patients are incapable to engage in decision-making when they present in acute care with a serious illness. By increasing the quality and quantity of ACP in primary care, patients’ will be better aligned with their values ultimately leading to tremendous improvements in overall quality of end-of-life (EOL) care and perhaps less intensification of care for some patients which will reduce overall healthcare costs.

About the Project

ACP is a process where people consider the various options related to future health care decisions and come up with a verbal or written plan of what care they would want (or not want) at the EOL. ACP has been shown to increase the quality of life of dying patients, improve the experience of family and health care professionals and decrease health care costs. Yet a national poll demonstrated that few Canadians have thought about, or made, an advance care plan. ACP should ideally be done in primary care where patients are not acutely ill, and can talk with their doctors with whom they have ongoing relationships.

To increase ACP in primary care, we are collaborating with 20 primary care settings in Ontario, British Columbia and Alberta that will help us develop, evaluate and implement ACP tools and strategies. In addition, we will be building a network of stakeholders interested in ACP in primary care and partnering with provincial and national organizations to share our findings.

For more details on the project rationale, objectives and research plan, click here.

Project Team

Principal Investigators:

Michelle Howard, PhD, MSc -- McMaster University

Doris Barwich, MD -- University of British Columbia

Daren Heyland, MD, MSc, BSc -- Queen’s University/Kingston General Hospital

Doug Klein, MD, MSc, BSc, CCFP(PC) -- University of Alberta


Carrie Bernard, MD, CCFP, FCFP -- McMaster University

Konrad Fassbender, PhD -- Covenant Health

Amy Tan, MD -- University of Alberta

Knowledge Users and Partners:

Louise Hanvey, RN -- Canadian Hospice Palliative Care Association (CHPCA)

Jessica Simon, BSc, MBChB, MRCP(UK), FRCPC -- University of Calgary

Marissa Slaven, MD -- McMaster University

Project Contact: Dr. Michelle Howard --

CORE 2013-13

Key words: advance care planning; primary care; palliative care; quality improvement