Strengths and limitations
generalised, chronic illness, chronic, life-limiting illness
CHRONIC ILLNESS
To the authors’ knowledge, this is the first study to examine ACP behaviour change processes using the ACP Engagement Survey in Belgium, as well as the first to examine its associations with GP communication. This validated instrument reflects behaviour change constructs for multiple components of ACP, which can provide insight beyond whether or not patients complete discrete actions. By exploring patient-related factors such as demographics and clinical characteristics, as well as patient perceptions of their GPs’ listening and information provision, the current study has further disentangled which factors are important in ACP engagement.Several limitations should be considered. This was a cross-sectional baseline assessment of a fairly limited sample of GPs and patients recruited in the context of an RCT in the Flanders and Brussels regions in Belgium. The findings can therefore not be generalised to the population with chronic illness and may differ for adults who have not had personal experience with chronic, life-limiting illness. Nevertheless, the focus was to explore factors associated with ACP engagement in this sample with chronic, life-limiting illness, which was achieved. As a result of the cross-sectional design, causality cannot be inferred. It is possible that patients who are more confident also participate more actively in conversations, and thus perceive their GP as listening to their concerns. Additionally, an attempt was made to limit recall bias by restricting questions about GPs’ information provision and listening to the 3 months before baseline assessment. Overall missingness for these items was limited, with no question missing >10%. Although data were collected about the patients’ perceptions of the quality of their GPs’ ACP communication, for the baseline assessment data were not collected about the timing, duration, and specific content of the pre-baseline consultation(s) during which these topics were discussed. As there is no single standardised process for ACP conversations in Belgium these conversations may vary from patient to patient. It may be useful for future research to also explore which aspects of the consultation(s) contribute to the patients’ perceptions.