Recognising the elephant in the room: Foundation doctors and anticipatory care planning

Article Figures & Data

Table 1.

Semi-structured interview question stems

Stem number	Question stem	Expanding themes
I	What do you understand by anticipatory care planning?	Have you had teaching at medical school or during foundation training? How does it impact on patient care?
II	What witnessed experiences have you had of anticipatory care planning?	Are you included in these discussions? Where did they take place? Did you feel it was an appropriate setting? Is your input encouraged? Who initiates these conversations: families or doctors? Why were they positive or negative? Were there disagreements or difficulties from family or staff?
III	What personal experience have you had in having these conversations with patients and their families?	Is it a part of your role; should it be? Is your input encouraged? How did you feel? Have you witnessed or have you been involved in futile resuscitation, where anticipatory care planning has not occurred? What effect did this have on you?
IV	Do you feel confident having these discussions?	Why/why not? What could be offered to you to increase this? What do you think are the main barriers?

Table 2.

Themes and interview quotations

Theme A: Understanding of and confidence in anticipatory care planning	Theme B: Variation in specialty	Theme C: Further educational needs
Doctor 5: ‘Resuscitation of patients who should never be undergoing resuscitation because the conversation hasn’t happened early enough. ’Doctor 1: ‘I think it’s something we should be doing more readily and earlier and trying to normalise. ’Doctor 8: ‘Juniors are the people who are more constant on the ward … the patients and families have a good relationship with the junior team.’	Doctor 4: ‘Stroke and elderly medicine are very on the ball … it’s fairly bread-and-butter for them it’s a common occurrence. ’Doctor 6: ‘In some specialties, it’s just not as much of a consideration. ’Doctor 7: ‘We need adequate clinical exposure and experience to make those decisions.’	Doctor 3: ‘Very much something that I have learnt on the job, watching my seniors do it … you learn buzzwords and you learn ways to say things that people don’t take offence to. ’Doctor 1: ‘I think with the way the Foundation Programme is structured, with a variety of different training days across the first couple of years, it’s certainly something that could be considered being put in within that curriculum.’