Editorials

Advance care planning in primary care

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39009.569861.80 (Published 26 October 2006) Cite this as: BMJ 2006;333:868
  1. Scott A Murray, St Columba's Hospice professor of primary palliative care ([email protected]),
  2. Aziz Sheikh, professor of primary care research and development,
  3. Keri Thomas, national clinical lead, palliative care (generalist)
  1. Primary Palliative Care Research Group, Division of Community Health Sciences: General Practice Section, University of Edinburgh, Edinburgh EH8 9DX
  2. Primary Palliative Care Research Group, Division of Community Health Sciences: General Practice Section, University of Edinburgh, Edinburgh EH8 9DX
  3. NHS End of Life Care Programme England, John Taylor Hospice, Birmingham B24 0DF

    Of the various trajectories of physical decline, organ failure is often the most difficult to plan for in advance because of its unpredictability.1 The qualitative study by Davison and Simpson in this week's BMJ challenges the notion that early discussion of planning for the end of life will destroy hope rather than create it. Rather, it allowed patients dying of end stage renal failure and their carers to reflect on and reorient their aspirations.2 A wealth of evidence indicates that many elderly patients want to discuss these issues with their healthcare professionals, but this rarely happens even when (as in the United Kingdom) continuity of care with a trusted general practitioner is available.34 The main barrier is probably doctors' reluctance to raise the issue of planning for death because of the largely unfounded fear of destroying hope.

    Advance care planning is practised in Australia, Canada, and the United States.57 It is also proposed …

    View Full Text

    Sign in

    Log in through your institution

    Free trial

    Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
    Sign up for a free trial

    Subscribe