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Improving General practice Advance care Planning (i-GAP)

If a person has communicated their end-of-life wishes with their health care providers and family members they are more likely to receive medical care that reflects their values and to be satisfied with the care they receive at that time. Thinking and talking about your values and wishes for what will happen if you are unable to make health care decisions for yourself is called Advance Care Planning (ACP).

A team of researchers in the Department of Family Medicine at McMaster University is trying to get more Canadians talking about ACP, especially with their family doctor. A survey taking place in family doctor offices across Alberta, British Columbia and Ontario found that 53 percent of Canadians had discussed ACP with someone, but only 18 percent had discussed it with their family doctor. When asked what makes it difficult to talk to their family doctor about ACP, patients responded that it is their doctor’s responsibility but acknowledge insufficient time, as well as concerns about having difficult conversations with their doctor as barriers. Doctors also report insufficient time to talk with patients about ACP, skepticism about transportability of ACP documentation, and insufficient tools and resources needed as barriers to ACP discussions with patients.

i-GAP tested the efficacy of seven online or paper Advance Care Planning tools as a way to help people, families and health care professionals have these important discussions. Findings show that ACP tools increase ACP engagement by 18%, particularly in knowledge and contemplation.  Most tools also show modest improvements in patient’s readiness to do ACP. More recently, i-GAP tested a novel web site tool called the Plan Well GuideTM, which is intended to help patients and their substitute decision maker (SDMs) prepare for in the moment decision making during a medical emergency.  The primary outcome is ACP Engagement among SDMs. Findings will be available soon.

Notable publications

Howard M, Bernard C, Klein D, Tan A, Slaven M, Barwich D, You JJ, Asselin G, Simon J, Heyland DK. Older Patient Engagement in Advance Care Planning in Canadian Primary Care Practices: Results of a multi-site survey. Canadian Family Physician 2018; 64(5):371-377.

Howard M, Bernard C, Klein D, Elston D, Tan A, Slaven M, Barwich D, You JJ, Heyland DK. Barriers to and enablers of advance care planning with patients in primary care: survey of health care providers. Canadian Family Physician 2018; 64(4): e190-198.

Howard M, Slaven M, Bernard C, Borhan S, Elston D, Arora N, Tan A, Heyland DK. Decision support intervention (Plan Well Guide) for patients and their substitute decision-makers to improve engagement in advance care planning: protocol for a randomised trial. BMJ Open 2019; 9:e027897.

Howard M, Robinson CA, McKenzie M, Fyles G, Sudore RL, Andersen E, Arora N, Barwich D, Bernard C, Elston D, Heyland R, Klein D, McFee E, Mroz L, Slaven M, Tan A, Heyland DK. Effectiveness of an interactive website to engage patients in advance care planning in outpatient settings: a multicentre, prospective, before-after study. Annals of Family Medicine 2020; 18(2):110-117.

Howard M, Langevin J, Bernard C, Tan A, Klein D, Slaven M, Barwich D, Elston D, Arora N, Heyland DK. Primary care clinicians’ confidence, willingness participation and perceptions of roles in advance care planning discussions with patients: a multi-site survey. Family Practice 2020; 37(2): 219-226.


Principal Investigators
  • Dr. Carrie Bernard, Queen Square Family Health Team
  • Dr. Marissa Slaven, Juravinski Cancer Centre
  • Dr. John You, Hamilton Health Sciences
  • Dr. Doug Klein, University of Alberta
  • Dr. Amy Tan, University of Calgary
  • Dr. Jessica Simon, Alberta Health Services
  • Dr. Doris Barwich, British Columbia Centre for Palliative Care
  • Dr. Rebecca Sudore, University of California at San Francisco

Partner Organizations