Table 3 What PCPs think would be successful primary care and community-led ACP activity connection approaches

Public awareness and outreach

“Advertisement on news, in local paper, social media”

“More public awareness of documents like care plans, MOST (Medical orders for scope of treatment), resuscitation orders”

“Well clearly we need to know about them, but more importantly, they need to be out in the community, like assisted livings and senior centres, promoting discussion so they are not so surprised when I do.”

Hardcopy resources for patients

“Easy to read patient handouts/pamphlets”

“Poster or handout that can be given to patient on how they can register for the session

Communication between activity coordinators and primary care providers

“Bringing the providers in both contexts together and have a discussion on how to best collaborate to provide patients with the conversations needed to provide ACP optimally”

“Virtual meeting with primary care providers, or even just an email sent to the clinic for them to inform us 1. that they exist 2. how to refer 3. what services they provide”

“Communication back to Primary care of attendance”

“A summary of what was discussed at session to come to GP (general practitioner)”

Easy referral process

“Facilitator based in practices, perhaps connected through health authority”

“Collaboration with primary care through patient care networks”

“Through divisions of family practice”

“Easy method of referral”

“Easy to find form/info on Pathways”

“Have a referral form available on all EMRs (electronic medical records)”

Follow-up for patient to connect with GP (general practitioner) after attending activity

“Have patients make an appointment with me once they’ve completed the activity”

“Start conversation and direct to physician”

“Form(s) to take to GP to complete the process”