1
Johnson BH. Promoting Patient- and Family-Centered Care Through Personal Stories.
Acad Med 2016;91:297–300. doi:10.1097/ACM.0000000000001086
2
Richards T, Coulter A, Wicks P. Time to deliver patient centred care. BMJ 2015;350:h530. doi:10.1136/bmj.h530
3
The Royal College of Physicians and Surgeons of Canada. The CanMEDS 2015 Framework.
2015.http://canmeds.royalcollege.ca/en/framework (accessed 10 Apr 2019).
4
Levenstein JH, McCracken EC, McWhinney IR, et al. The patient-centred clinical method.
1. A model for the doctor-patient interaction in family medicine. Fam Pract 1986;3:24–30.http://www.ncbi.nlm.nih.gov/pubmed/3956899 (accessed 28 Aug 2015).
5
McWhinney IR. A Textbook of Family Medicine. Second. New York, NY: : Oxford University
Press 1997.
6
CanMEDs Family Medicine. Working group on curriculum review. 2009. http://www.cfpc.ca/uploadedFiles/Education/CanMeds FM Eng.pdf
7
Heyland DK, Dodek P, Rocker G, et al. What matters most in end-of-life care: perceptions
of seriously ill patients and their family members. CMAJ 2006;174:627–33. doi:10.1503/cmaj.050626
8
Teno JM, Fisher ES, Hamel MB, et al. Medical care inconsistent with patients’ treatment
goals: association with 1-year Medicare resource use and survival. J Am Geriatr Soc
2002;50:496–500.http://www.ncbi.nlm.nih.gov/pubmed/11943046 (accessed 10 Jul 2015).
9
You JJ, Dodek P, Lamontagne F, et al. What really matters in end-of-life discussions?
Perspectives of patients in hospital with serious illness and their families. CMAJ
2014;186:E679-87. doi:10.1503/cmaj.140673
10
Heyland DK, Ilan R, Jiang X, et al. The prevalence of medical error related to end-of-life
communication in Canadian hospitals: results of a multicentre observational study.
BMJ Qual Saf 2015;25:671–9. doi:10.1136/bmjqs-2015-004567
11
Wenger NS, Oye RK, Bellamy PE, et al. Prior capacity of patients lacking decision
making ability early in hospitalization: implications for advance directive administration.
The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes
and Risks of Treatments. J Gen Intern Med 1994;9:539–43.http://www.ncbi.nlm.nih.gov/pubmed/7823223 (accessed 26 Apr 2016).
12
Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision
making before death. N Engl J Med 2010;362:1211–8. doi:10.1056/NEJMsa0907901
13
Sinuff T, Dodek P, You JJ, et al. Improving End-of-Life Communication and Decision
Making: The Development of Conceptual Framework and Quality Indicators. J Pain Symptom
Manage 2015;49:1070–80. doi:10.1016/j.jpainsymman.2014.12.007
14
Brinkman-Stoppelenburg A, Rietjens JAC, van der Heide A. The effects of advance care
planning on end-of-life care: a systematic review. Palliat Med 2014;28:1000–25. doi:10.1177/0269216314526272
15
Houben CHM, Spruit MA, Groenen MTJ, et al. Efficacy of advance care planning: a systematic
review and meta-analysis. J Am Med Dir Assoc 2014;15:477–89. doi:10.1016/j.jamda.2014.01.008
16
Taneja R, Faden LY, Schulz V, et al. Advance care planning in community dwellers:
A constructivist grounded theory study of values, preferences and conflicts. Palliat
Med 2019;33:66–73. doi:10.1177/0269216318803487
17
Dying in America: Improving the quality and honoring individual preferences near the
end of life. Washington, DC: : National Academies Press 2014.
18
Perkins HS. Controlling death: the false promise of advance directives. Ann Intern
Med 2007;147:51–7.http://www.ncbi.nlm.nih.gov/pubmed/17606961 (accessed 1 Dec 2015).
19
Smith AK, Lo B, Sudore R. When Previously Expressed Wishes Conflict With Best Interests.
JAMA Intern Med 2013;173:1241. doi:10.1001/jamainternmed.2013.6053
20
Heyland DK, Frank C, Groll D, et al. Understanding Cardiopulmonary Resuscitation Decision
Making. Chest 2006;130:419–28. doi:10.1378/chest.130.2.419
21
Schickedanz AD, Schillinger D, Landefeld CS, et al. A Clinical Framework for Improving
the Advance Care Planning Process: Start with Patients’ Self-Identified Barriers.
J Am Geriatr Soc 2009;57:31–9. doi:10.1111/j.1532-5415.2008.02093.x
22
Sudore RL, Lum HD, You JJ, et al. Defining Advance Care Planning for Adults: A Consensus
Definition from a Multidisciplinary Delphi Panel. J Pain Symptom Manage 2017;53:821–32. doi:10.1016/j.jpainsymman.2016.12.331
23
Lum HD, Barnes DE, Katen MT, et al. Improving a Full Range of Advance Care Planning
Behavior Change and Action Domains: The PREPARE Randomized Trial. J Pain Symptom Manage
2018;56:575-581.e7. doi:10.1016/j.jpainsymman.2018.06.007
24
Howard M, Bernard C, Klein D, et al. Older patient engagement in advance care planning
in Canadian primary care practices Results of a multisite survey. Can Fam Physician
2018;64:371–7.http://www.cfp.ca/content/64/5/371
25
The College of Family Physicians of Canada. A Vision for Canada: Family Practice-The
Patient’s Medical Home. Position Paper. Toronto: 2001. http://www.cfpc.ca/A_Vision_for_Canada/#sthash.AQ2d3iZQ.dpuf
26
Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a
map? J Contin Educ Health Prof 2006;26:13–24. doi:10.1002/chp.47
27
Advance Care Planning in Canada: National Framework and Implementation Task Group.
Canadian Hospice Palliative Care Association. Advance care planning in Canada: a national
framework for consultation. 2010.http://www.advancecareplanning.ca/about-advance-care-planning/advance-care-planning-national-task-group/ (accessed 30 Nov 2015).
28
Canada PHA of. Canadian Task Force on Preventive Health Care. 2015.http://canadiantaskforce.ca/ (accessed 30 Nov 2015).
29
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty
in elderly people. CMAJ 2005;173:489–95. doi:10.1503/cmaj.050051
30
O’Sullivan R, Mailo K, Angeles R, et al. Advance directives: survey of primary care
patients. Can Fam Physician 2015;61:353–6.http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4396762&tool=pmcentrez&rendertype=abstract (accessed 14 Jun 2015).
31
Aitken P. Incorporating Advance Care Planning into Family Practice. Am Fam Physician
1999;59:605–12.https://www.aafp.org/afp/1999/0201/p605.html (accessed 15 May 2019).
32
Dhillon K, Jerome D, Teeluck R, et al. Advance care planning in family medicine training.
Can Fam Physician 2018;64:394–6.http://www.ncbi.nlm.nih.gov/pubmed/29760262 (accessed 15 May 2019).
33
De Vleminck A, Houttekier D, Pardon K, et al. Barriers and facilitators for general
practitioners to engage in advance care planning: a systematic review. Scand J Prim
Health Care 2013;31:215–26. doi:10.3109/02813432.2013.854590
34
You JJ, Fowler RA, Heyland DK. Just ask: discussing goals of care with patients in
hospital with serious illness. CMAJ 2014;186:425–32. doi:10.1503/cmaj.121274
35
Association CHPC. Primary Care Toolkit. Adv. Care Plan. www.advancecareplanning.ca/health-care-professionals/about-advance-care-planning/primary-care-toolkit.aspx. (accessed 8 Sep 2015).
36
Tung EE, North F. Advance Care Planning in the Primary Care Setting: A Comparison
of Attending Staff and Resident Barriers. Am J Hosp Palliat Med 2009;26:456–63. doi:10.1177/1049909109341871
37
Lund S, Richardson A, May C. Barriers to advance care planning at the end of life:
an explanatory systematic review of implementation studies. PLoS One 2015;10:e0116629. doi:10.1371/journal.pone.0116629
38
Howard M, Bernard C, Klein D, et al. Barriers to and enablers of advance care planning
with patients in primary care. Can Fam Physician 2018;64:190–8.
39
Tan A, Manca D. Finding common ground to achieve a ‘good death’: family physicians
working with substitute decision-makers of dying patients. A qualitative grounded
theory study. BMC Fam Pract 2013;14:14. doi:10.1186/1471-2296-14-14
40
Tung EE, Vickers KS, Lackore K, et al. Clinical decision support technology to increase
advance care planning in the primary care setting. Am J Hosp Palliat Care 2011;28:230–5. doi:10.1177/1049909110386045
41
Slort W, Blankenstein AH, Deliens L, et al. Facilitators and barriers for GP–patient
communication in palliative care: a qualitative study among GPs, patients, and end-of-life
consultants. Br J Gen Pract 2011;61:e167–72. doi:10.3399/bjgp11X567081
42
Gallagher R. An approach to advance care planning in the office. Can Fam Physician
2006;52.http://www.cfp.ca/content/52/4/459?ijkey=7823904a9b45cc43d944e8ba9630b3c28a4eb159&keytype2=tf_ipsecsha (accessed 22 Feb 2019).
43
Arnett K, Sudore RL, Nowels D, et al. Advance Care Planning: Understanding Clinical
Routines and Experiences of Interprofessional Team Members in Diverse Health Care
Settings. Am J Hosp Palliat Med 2016;34:946–53. doi:10.1177/1049909116666358
44
Sudore RL, Boscardin J, Feuz MA, et al. Effect of the PREPARE Website vs an Easy-to-Read
Advance Directive on Advance Care Planning Documentation and Engagement Among Veterans.
JAMA Intern Med 2017;177:1102–9. doi:10.1001/jamainternmed.2017.1607
45
Fried TR, Bullock K, Iannone L, et al. Understanding advance care planning as a process
of health behavior change. J Am Geriatr Soc 2009;57:1547–55. doi:10.1111/j.1532-5415.2009.02396.x
46
Curtis JR, Patrick DL, Caldwell ES, et al. Why don’t patients and physicians talk
about end-of-life care? Barriers to communication for patients with acquired immunodeficiency
syndrome and their primary care clinicians. Arch Intern Med 2000;160:1690–6.http://www.ncbi.nlm.nih.gov/pubmed/10847263 (accessed 10 Apr 2019).
47
Hickman RL, Daly BJ, Lee E. Decisional conflict and regret: Consequences of surrogate
decision making for the chronically critically ill. Appl Nurs Res 2012;25:271–5. doi:10.1016/j.apnr.2011.03.003
48
Wendler D, Rid A. Systematic review: the effect on surrogates of making treatment
decisions for others. Ann Intern Med 2011;154:336–46. doi:10.7326/0003-4819-154-5-201103010-00008
49
Chiarchiaro J, Buddadhumaruk P, Arnold RM, et al. Prior Advance Care Planning Is Associated
with Less Decisional Conflict among Surrogates for Critically Ill Patients. Ann Am
Thorac Soc 2015;12:1528–33. doi:10.1513/AnnalsATS.201504-253OC
50
Census Canada: National Household Survey. Ottawa, Canada: 2011.