European Journal of General Practice最新文献

{"title":"Variations in general practitioners' referrals to low-value MRI examinations in Norway: A nationwide register-based study.","authors":"Eivor H Hoff, Bjørn M Hofmann, Kristian B Kraft, Arnstein Mykletun, Kristian A Østby","doi":"10.1080/13814788.2026.2706207","DOIUrl":"10.1080/13814788.2026.2706207","url":null,"abstract":"<p><strong>Background: </strong>Large variations in diagnostic imaging use raise concerns about low-value care, inequity, and inefficient use of resources. Magnetic resonance imaging (MRI) of the head, lumbosacral spine, and knee has been identified as potentially low-value examinations in several clinical contexts.</p><p><strong>Objectives: </strong>To examine variation in general practitioners' referrals to low-value MRI examinations in Norway and assess whether differences are associated with GP and practice characteristics.</p><p><strong>Methods: </strong>Using national registry data, we linked patients' completed MRI examinations to their regular GP and calculated GP-specific MRI rates per 1000 listed patients. We classified GPs into deciles and compared the characteristics of GPs in the highest (High-10) and lowest (Low-10) referral deciles. We examined predictors of variation using pooled OLS regression models with year fixed effects and GP-clustered standard errors.</p><p><strong>Results: </strong>GPs in the top referring decile (High-10) referred patients for potentially low-value MRI examinations at three times the rate of those in the lowest referring decile (Low-10). Experienced (specialist-certified) GPs referred approximately 2.7 fewer examinations per 1000 listed patients per year than less experienced GPs (non-specialists). Shorter consultation times, higher consultation frequency and higher hourly fee income were all associated with higher MRI use - with the strongest association for private MRI. A higher patient disease burden was associated with more total examination, but fewer private examinations per 1000 listed patients per year.</p><p><strong>Conclusion: </strong>Referral rates varied markedly between GPs. Specialist-certified GPs had lower rates than non-specialists, and higher activity levels and income from fees were associated with higher referral rates - particularly to private providers.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2706207"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers for general practitioners in post-stroke follow-up within a fragmented healthcare system in Sweden - a focus group study.","authors":"Maria Wolf, Maria Flink, Axel C Carlsson, Mia von Euler, Jan Hasselström","doi":"10.1080/13814788.2026.2728342","DOIUrl":"10.1080/13814788.2026.2728342","url":null,"abstract":"<p><strong>Background: </strong>Secondary medical prevention after stroke is effective and well evidenced, making long-term follow-up crucial. This follow-up is mainly made by general practitioners (GPs) in Sweden. Low target achievement and up to fourfold practice variation in dispensation of secondary preventive drugs between different primary care units in Region Stockholm has been described. Although several factors in individual practices have been observed to be associated with insufficient target achievements, the underlying reasons for this variation are unclear.</p><p><strong>Objectives: </strong>To explore the perspectives of GPs concerning secondary preventive practices after stroke to shed light on areas of improvement.</p><p><strong>Methods: </strong>This qualitative study was based on eight focus group discussions with 49 GPs in Region Stockholm. They were strategically invited in relation to target achievement, and the interviews (45-55 min) were conducted using a semi-structured interview guide. The interviews were transcribed and analysed using qualitative content analysis.</p><p><strong>Results: </strong>There were two themes: \"Multifaceted mission in an insufficiently organized healthcare system\" and \"The complexity of adherence\". There were six categories that encompassed shortcomings in the areas of: sufficient time for the patients, the overarching structure of the healthcare system, the internal structure of follow-ups, medical adherence, the responsibility for renewals of medication and tools for adherence.</p><p><strong>Conclusion: </strong>The perspectives of GPs revealed structural problems at different levels in the health care system as well as difficulties in handling medication adherence indicating a need for improvement. GPs touched on solutions including increasing the number of GPs, education and improved referrals from hospital to primary care.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2728342"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential and pitfalls of personal reference intervals in general practice: A focus group and case vignette study among Dutch general practitioners.","authors":"R A Krimpenfort, Y M Drewes, W P J den Elzen, R K E Poortvliet, B A de Boer, A M de Jong","doi":"10.1080/13814788.2026.2729220","DOIUrl":"10.1080/13814788.2026.2729220","url":null,"abstract":"<p><strong>Background: </strong>Personalised medicine is increasingly used in clinical practice and tailors care to individual characteristics. A new application in laboratory diagnostics is personalised reference intervals (PeRIs). Unlike population-based reference intervals (PoRIs), PeRIs use previous results of the patient, providing ranges tailored to an individual's own baseline. This may improve interpretation of laboratory results and possibly patient care.</p><p><strong>Objectives: </strong>This study aims to explore perspectives of general practitioners (GPs) on PeRIs, and maps the identified benefits, disadvantages, risks and prerequisites before implementation of PeRIs.</p><p><strong>Methods: </strong>Focus groups (<i>n</i> = 3; 16 GPs) and a vignette study with fictional cases (<i>n</i> = 98) were used to explore the opinion, interpretation and application of PeRIs among Dutch GPs.</p><p><strong>Results: </strong>Focus groups and the survey identified benefits, including easier interpretation, efficiency and more meaningful follow-up and referrals, as well as risks such as alert fatigue, overreliance, and underdiagnosis. The survey showed that PeRIs may alter GP behaviour. When a haemoglobin result was presented with versus without a PeRI comment, a significant portion of GPs adjusted their clinical strategy in these fictional cases. Participants emphasised that PeRIs should support, not replace clinical judgement.</p><p><strong>Conclusion: </strong>Our study reveals arguments both supporting and opposing PeRIs. Importantly, GPs perceived added value for diagnostic decision-making. We advise accompanying implementation of PeRI with education on responsibilities and underlying algorithms. In this way, PeRIs can contribute to behavioural change that may lead to better and more meaningful, personalised care.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2729220"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1080/13814788.2026.2620941","DOIUrl":"10.1080/13814788.2026.2620941","url":null,"abstract":"","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2620941"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventive strategies for recurrent urinary tract infections in premenopausal women: A scoping review.","authors":"Caroline Skovsbo Clausen, Louise Bidstrup Jørgensen, Rune Aabenhus, Sif Helene Arnold, Katrine Hartung Hansen, Lars Bjerrum, Mette Bech Risør, Anne Holm","doi":"10.1080/13814788.2026.2661165","DOIUrl":"10.1080/13814788.2026.2661165","url":null,"abstract":"<p><strong>Background: </strong>Recurrent urinary tract infection (rUTI) in women is common in primary care. Antibiotics can prevent rUTI, but their use is associated with the risk of developing antimicrobial resistance. Thus, non-antibiotic strategies are needed, yet evidence remains limited due to methodologically weak studies. Consequently, potentially effective strategies lack sufficient evidence for guideline inclusion, leaving healthcare professionals (HCPs) and women with little support. This scoping review synthesises preventive strategies for rUTIs in premenopausal women, mapping recommendations and underlying rationales to guide future research and guideline development.</p><p><strong>Methods: </strong>This Scoping review was conducted by searching PubMed, Cochrane, EMBASE, Web of Science, and CINAHL. 6170 records were identified for eligibility. A total of 78 publications were included, i.e. reviews, guidelines, and expert reports regarding preventive strategies used for rUTIs for premenopausal women, published between January 2013 and December 2023.</p><p><strong>Results: </strong>78 publications addressed rUTIs prevention in premenopausal women, encompassing both well-studied strategies, such as antibiotic regimens and cranberry products, and less-studied approaches, including behavioural modifications, vitamin supplements, and increased hydration. Recommendations were often unsupported by evidence, and disagreement among sources was common.</p><p><strong>Discussion: </strong>To support women with rUTIs, HCPs require an overview of preventive strategies including supporting recommendations and evidence. Our findings highlight a clear contrast between well-studied strategies, such as antibiotic regimens, and behavioural strategies, where evidence is limited, often because some cannot feasibly be evaluated in randomised trials rather than due to limited clinical relevance. These findings may help HCPs and guideline developers assess evidence and prioritise future research.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2661165"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gabapentinoids and unexplained death in general practice: Case series and feasibility study arising from a critical incident.","authors":"Augustin Gabriel, Tom Fahey","doi":"10.1080/13814788.2026.2645473","DOIUrl":"10.1080/13814788.2026.2645473","url":null,"abstract":"<p><strong>Background: </strong>Prescribing epidemiology in general practice shows gabapentinoid drugs to be independently associated with unexpected, drug-related death. There is an increasing trend of gabapentinoid deaths throughout Europe and North America.</p><p><strong>Objectives: </strong>The overall aim of this study was to assess how patient, practice and health system factors might be associated with gabapentinoid prescribing in primary care.</p><p><strong>Methods: </strong>Case series following a critical incident of an unexpected death in a patient prescribed a gabapentinoid drug in a single general practice. Unexpected and expected deaths in patients prescribed a gabapentinoid drug deaths over an 11-year period in a single general practice. We examined patient, prescriber and health system factors. Toxicology and post-mortem data were provided by the Coroner.</p><p><strong>Results: </strong>There were 36 deaths (four unexpected and 32 expected deaths) during the study period. Of the four patients who suffered an unexpected death, one of these patients' cause of death could be attributed to drug and alcohol toxicity. Over half of gabapentinoid prescribing (<i>n</i> = 19,53%) was hospital initiated, often 'off-label' (<i>n</i> = 6, 17%) and commonly co-prescribed with opiates (<i>n</i> = 15, 42%) and benzodiazepines (<i>n</i> = 11, 31%) to patients with high multi-morbidity.</p><p><strong>Conclusions: </strong>Gabapentinoids are often initiated in the outpatient setting in clinically complex patients, often for 'off label' indications, with high polypharmacy. Patient, practice and health-system related factors need to be addressed in relation to gabapentinoid associated deaths and reflected in clinical practice guidelines. There is critical value in using toxicology reports from Coroner's offices in cases of unexplained gabapentinoid death in general practice.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2645473"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding competencies to manage multimorbidity in primary care: A focus group study with professionals and patients.","authors":"Leslie J Michielsen, Lena H A Raaijmakers, Miranda Laurant, Erik Bischoff, Geert M Rutten, Tjard R Schermer","doi":"10.1080/13814788.2026.2721007","DOIUrl":"10.1080/13814788.2026.2721007","url":null,"abstract":"<p><strong>Background: </strong>Chronic conditions often occur as multimorbidity, where patients experience multiple chronic conditions simultaneously. Many developed countries have implemented disease management programmes (DMP) in primary care to address these complex needs, but their success largely depends on the competencies of healthcare professionals. Equipping primary care professionals with the competencies required for person-centred integrated care (PC-IC) is therefore essential.</p><p><strong>Aim: </strong>This study aims to 1(1) identify the competencies primary care professionals consider essential for providing PC-IC to patients with chronic conditions and multimorbidity and examine their alignment with patient preferences, and 2(2) explore professionals' training needs.</p><p><strong>Methods: </strong>This qualitative study used focus group interviews to explore perspectives on PC-IC. A convenience sample included 14 primary care professionals (general practitioners and practice nurses) and a purposive sample included 10 patients with one or more chronic conditions.</p><p><strong>Results: </strong>Primary care professionals identified person-centred attitudes, communication skills and interprofessional collaboration as essential competencies for delivering person-centred integrated care. Patients similarly valued being heard, understood, and actively involved in decision-making, while additionally emphasising continuity and coordinated care. Professionals also emphasised ongoing training, reflective practice groups, case discussions, and practical communication tools as important for developing these competencies.</p><p><strong>Conclusions: </strong>Successful implementation of PC-IC requires more than disease-specific expertise. It depends on individual competencies, effective interprofessional collaboration, and organisational conditions that support coordinated, person-centred care. Ongoing professional development may help strengthen these competencies in primary care.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2721007"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond clinical care: A qualitative study on the leadership role of general practitioners in dutch interprofessional care for older adults.","authors":"Loreen M H Merx, Anneke van Dijk-de Vries, Henk J Schers, Sara Chardon-Wrenger, Marloes A van Bokhoven","doi":"10.1080/13814788.2026.2715197","DOIUrl":"10.1080/13814788.2026.2715197","url":null,"abstract":"<p><strong>Background: </strong>Frail older adults increasingly require coordinated, interprofessional primary care, yet leadership within these loosely organised teams is often informal and poorly understood. While general practitioners (GPs) are often seen as having a central role in leadership, little is known about how they themselves perceive and enact this role.</p><p><strong>Objectives: </strong>To explore how Dutch GPs understand and operationalise informal leadership within interprofessional primary care teams caring for frail older adults.</p><p><strong>Methods: </strong>A qualitative interview study was conducted with ten Dutch GPs using semi-structured interviews. Data were analysed inductively through thematic analysis.</p><p><strong>Results: </strong>GPs expressed ambivalence about being labelled as 'leaders', associating the term with hierarchy. Nonetheless, they enacted leadership through responsibilities embedded in everyday practice, including ensuring continuity of care, coordinating professionals, and maintaining oversight. Leadership was largely pragmatic and reactive: GPs often initiated collaboration and provided oversight but rarely engaged in shared goal setting or facilitating team learning. Satisfaction with current collaboration and competing priorities resulted in limited motivation to optimise interprofessional practice.</p><p><strong>Conclusion: </strong>GPs enact informal leadership primarily through responsibility and accountability for continuity and oversight rather than through strategic or explicitly shared leadership practices. Because collaboration is generally perceived as adequate, motivation to further develop team processes appears limited. More strategic elements, such as shared goal setting and proactive team learning, are less developed. Strengthening awareness of leadership roles within interprofessional teams may support more balanced responsibility-sharing and enhance care for frail older adults.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2715197"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy and management of suspected acute otitis media: A multi-continental survey of primary care physicians using tympanic membrane images in clinical cases.","authors":"Ida Lindman, Lisa Ahlstrand, Thorbjörn Lundberg, Anna Moberg, Karin Mossberg, Lidia Caballero, Clare Heal, Samuel Coenen, Ingrid Picard, Hanna Kaduszkiewicz, Catharina Escales, Julia Hansmann-Wiest, Noirin Fitzgerald, Tomoko Ito, Guro Haugen Fossum, Anja Maria Braend, Owen Eales, Sanele Ngcobo, Carl Llor, Oliver Van Hecke, Mark Ebell, Ronny Gunnarsson, Pär-Daniel Sundvall","doi":"10.1080/13814788.2026.2726138","DOIUrl":"10.1080/13814788.2026.2726138","url":null,"abstract":"<p><strong>Background: </strong>Acute otitis media (AOM) is a leading cause of primary care visits and antibiotic prescriptions in children. Diagnostic uncertainty and variability in management contribute to misdiagnosis and inappropriate antibiotic use.</p><p><strong>Objective: </strong>This study examines how primary care physicians across countries diagnose and manage suspected AOM through clinical cases.</p><p><strong>Methods: </strong>International cross-sectional survey using structured clinical cases with validated tympanic membrane images. The survey was administered during professional meetings for primary care physicians in 12 countries (Argentina, Australia, Belgium, Germany, Ireland, Japan, Norway, South Africa, Spain, Sweden, United Kingdom, and the United States).</p><p><strong>Results: </strong>A total of 1,365 primary care physicians participated. Across all responses to AOM cases, 60% were correctly diagnosed as AOM, while only 31% of responses involving a normal tympanic membrane were correctly identified. Antibiotic prescribing varied substantially across countries and between cases. Multivariable regression analyses showed that diagnostic accuracy was a significant predictor of antibiotic prescribing. Physicians who correctly identified a normal tympanic membrane were significantly less likely to prescribe antibiotics (p < 0.001). Notable differences in prescribing patterns were evident between countries.</p><p><strong>Conclusion: </strong>Diagnostic accuracy for suspected AOM was generally low among primary care physicians, with wide variation across countries. Antibiotics were frequently prescribed even in the absence of AOM. This underscores the need for improved diagnostic education to reduce unnecessary antibiotic use globally.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2726138"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advance care planning in people with intellectual disabilities, more than 'to resuscitate or not to resuscitate': A qualitative interview study with general practitioners and family caregivers.","authors":"Marnix De Grim, Jakke Hauman, Oliwia Zmysłowska, Sophie Opsomer, Johan Wens, Anke Van Dijck, Annelies Colliers","doi":"10.1080/13814788.2026.2745929","DOIUrl":"https://doi.org/10.1080/13814788.2026.2745929","url":null,"abstract":"<p><strong>Background: </strong>Advance care planning for people (ACP) with intellectual disabilities requires timely and carefully communication between family caregivers and general practitioners.</p><p><strong>Objectives: </strong>Despite its recognised importance, little is known about how these stakeholders experience advance care planning and decision-making processes, particularly regarding goals of care and do not resuscitate (DNR) orders, highlighting a critical gap in ensuring person-centred palliative care for this population.</p><p><strong>Methods: </strong>A qualitative design was used to investigate how Belgian general practitioners and family caregivers of adults (≥18 years) with moderate to profound intellectual disabilities (IQ ≤ 50) approach and experience decision-making about treatment goals and DNR directives. The data were analysed thematically.</p><p><strong>Findings: </strong>Interviews with six family caregivers and five general practitioners identified six themes: limited preparedness for ACP, the need for open discussion, communication challenges, involvement of key stakeholders, timing, and positive outcomes. Participants reported limited ACP knowledge and a need for earlier, broader conversations that extend beyond DNR decisions. Emotional barriers, uncertainty, and concerns about discussing end-of-life care too early often delayed ACP. Family caregivers generally expected GPs to initiate discussions, while both groups emphasised multidisciplinary involvement and timely, proactive conversations. Despite challenges, ACP discussions were often experienced as reassuring and helpful.</p><p><strong>Conclusions: </strong>ACP for adults with moderate to profound intellectual disabilities is shaped by knowledge gaps, communication barriers, and uncertainty about timing. Early, proactive, and multidisciplinary approaches that address personal values alongside treatment preferences may support person-centred decision-making and improve experiences of end-of-life planning.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2745929"},"PeriodicalIF":2.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}