Advance Care Planning in general practice: a retrospective study in The Netherlands

Abstract

Introduction: ACP assists to align care with personal values in the palliative phase. GPs are well- positioned to facilitate ACP, but barriers are experienced, especially for patients with unpredictable disease progress. This study examines documentation of ACP across different illness trajectories, including the association of ACP with end-of-life healthcare utilization and place of death. Methods: This retrospective observational study examined medical records from Dutch GPs of patients who died between 2022 and 2025. Patients were classified by main diagnosis (oncological, organ failure, neurological) and ACP documentation from the last 3 years of life was recorded. Data were extracted and analyzed. Statistical comparisons were performed and significance provided as p < 0.05. Results: Of the 219 patients, 65.8% had ACP documentation, which was most prevalent (62.5%) and comprehensive among the oncological group. ACP conversations primarily addressed end- of-life treatments, while personal themes and advanced directives were less commonly documented. Patients with ACP documentation had significantly fewer hospital admissions at the last month of life (50.5% versus 25.0%, p < 0.001). Furthermore, ACP was associated with dying at home, while non-ACP patients most frequently died in-hospital (41.3% and 43.7%, p < 0.001). Conclusion: ACP documentation deserves more attention in patients with less predictable disease trajectories. Conversations are primarily concerned with end-of-life treatments, highlighting the need for greater emphasis on personal values and advanced directives. The association between ACP documentation and lower hospital-based healthcare utilization and in- hospital deaths suggests that systematic ACP documentation in general practice may play an important role in end-of-life care.