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Background Advance care planning (ACP) facilitates communication and understanding of preferences, nevertheless the use of ACPs in primary care is low. The uncertain course of dementia and the inability to communicate with the patient living with dementia are significant challenges for GPs to initiate discussions on goals of care. Methods A cross-sectional survey, using a purposive, cluster sample of GPs across Northern Ireland with registered dementia patients was used. GPs at selected practices received the survey instrument and up to four mail contacts was implemented. Results One hundred and thirty-three GPs (40.6%) participated in the survey, representing 60.9% of surveyed practices. While most respondents regarded dementia as a terminal disease (96.2%) only 37.6% felt that palliative care applied equally from the time of diagnosis to severe dementia. While most respondents thought that early discussions would facilitate decision-making during advanced dementia (61%), respondents were divided on whether ACP should be initiated at the time of diagnoses. While most respondents felt that GPs should take the initiative to introduce and encourage ACP, most survey participants acknowledged the need for improved knowledge to involve families in caring for patients with dementia at the end of life and that a standard format for ACP documentation was needed. Conclusion Optimal timing of ACP discussions should be determined by the readiness of the patient and family carer to face end of life. ACP discussions can be enhanced by educational strategies directed towards the patient and family carer that enable shared decision-making with their GP when considering options in future care. Electronic supplementary material The online version of this article (doi:10.1186/s12904-015-0019-x) contains supplementary material, which is available to authorized users.

In its exploration of the reading possibilities of a domestic geography metaphor, this article highlights an engagement with the natural world as both embodied experience and textual practice in Nan Shepherd's neglected prose work, The Living Mountain . Domestic geography is intended as a pathway which shows how the structure and content of this text are inseparable and, by highlighting the complex narrative arrangement of The Living Mountain, privileges the textual representation of an engagement with the natural world from the perspective of a native dweller. In unearthing this forgotten native perspective on the Scottish landscape, the article examines how Shepherd uncovers the hidden ideological nature of the dominant discourses - of science, history, romanticism and landscape aesthetics - which have come to define the Scottish landscape. Drawing on the limited biographical material available on Shepherd, and in a close reading of the text itself, the article shows that both the Cairngorm Mountains an...

Background Advance care planning (ACP) facilitates communication and understanding of preferences, nevertheless the use of ACPs in primary care for patients with dementia is low. The disease’s uncertain course and the inability to communicate with the patient living with dementia are significant challenges for GPs. Aim The purpose of this study was to describe the attitudes and practice preferences of GPs working within the UK’s National Health System (NHS) regarding communication, and decision-making for patients with dementia and their families Methods A cross-sectional survey, using a purposive, cluster sample of GPs across Northern Ireland with registered dementia patients was used. Results One hundred and thirty-three GPs (40.6%) participated in the survey, representing 60.9% of surveyed practices. While most respondents regarded dementia as a terminal disease (96.2%) only 37.6% felt that palliative care applied equally from the time of diagnosis to severe dementia. While most respondents thought that early discussions would facilitate decision-making during advanced dementia (61%), respondents were divided on whether ACP should be initiated at the time of diagnoses (39.8% in favour vs 45.8% disagreed). Interestingly, GPs who were longer in practice placed greater importance on the presence of an advance directive (F (2, 124) = 3.38, p = 0.037). Discussion The timing of initiating ACP varies across individuals requiring GPs to carefully consider strategies and receptiveness of the patient and family carer. Conclusion The findings promote both ongoing training in communication and dementia management for GPs to meet the needs of their patients living with dementia