Advance care planning in residential care

Nair, Balakrishnan; Kerridge, Ian; Dobson, Annette; McPhee, John; Saul, Peter

doi:10.1111/j.1445-5994.2000.tb00835.x

Cited by 49 publications

(47 citation statements)

References 19 publications

(1 reference statement)

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“…This paper presents the key findings of the pre-implementation evaluation; post-implementation changes to these findings will be reported in a future paper. We hypothesised that although pre-implementation ACP awareness and practice within the project facilities may be higher than previously reported, in line with previous research in this area,4 28 30 33 34 the quality of ACP practices would be highly variable.…”

supporting

confidence: 63%

“…The legislation varies in terminology, intent and associated physician liability 27 28. A number of studies have examined aspects of ACP in Australia, including guidelines for implementing ACP in Australian healthcare settings,1 4 29 30 the roles of different health practitioners in supporting ACP,31–34 and the outcomes of a randomised controlled trial in which elderly patients were allocated to receive usual care or facilitated ACP 6. In the specific context of Australian residential aged care facilities (RACFs), development of advance care plans may or may not be part of the institution's policy, and in those settings where the importance of the ACP process is recognised, the quality of processes and instruments developed has been found to be variable and often questionable 4 28 30 33 34.…”

mentioning

confidence: 99%

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Quality of advance care planning policy and practice in residential aged care facilities in Australia

Silvester

Fullam

Parslow

et al. 2012

BMJ Support Palliat Care

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ObjectivesTo assess existing advance care planning (ACP) practices in residential aged care facilities (RACFs) in Victoria, Australia before a systematic intervention; to assess RACF staff experience, understanding of and attitudes towards ACP.DesignSurveys of participating organisations concerning ACP-related policies and procedures, review of existing ACP-related documentation, and pre-intervention survey of RACF staff covering their role, experiences and attitudes towards ACP-related procedures.Setting19 selected RACFs in Victoria.Participants12 aged care organisations (representing 19 RACFs) who provided existing ACP-related documentation for review, 12 RACFs who completed an organisational survey and 45 staff (from 19 RACFs) who completed a pre-intervention survey of knowledge, attitudes and behaviour.ResultsFindings suggested that some ACP-related practices were already occurring in RACFs; however, these activities were inconsistent and variable in quality. Six of the 12 responding RACFs had written policies and procedures for ACP; however, none of the ACP-related documents submitted covered all information required to meet ACP best practice. Surveyed staff had limited experience of ACP, and discrepancies between self reported comfort, and levels of knowledge and confidence to undertake ACP-related activities, indicated a need for training and ongoing organisational support.ConclusionsSurveyed organisations â policies and procedures related to ACP were limited and the quality of existing documentation was poor. RACF staff had relatively limited experience in developing advance care plans with facility residents, although attitudes were positive. A systematic approach to the implementation of ACP in residential aged care settings is required to ensure best practice is implemented and sustained.

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supporting

confidence: 63%

mentioning

confidence: 99%

Quality of advance care planning policy and practice in residential aged care facilities in Australia

Silvester

Fullam

Parslow

et al. 2012

BMJ Support Palliat Care

View full text Add to dashboard Cite

show abstract

“…[41][42][43][44][45] Nair et al 45 surveyed Directors of Care regarding the relative use of formal and informal methods of advanced care planning in 88 residential aged care facilities in the Hunter region of New South Wales. They found low levels of formal methods of advanced care planning; only 0.2% of residents had an advanced directive, 1.1% of residents had no CPR orders documented in their medical records, 5.6% had a formal guardian and 2.8% had an enduring guardian.…”

Section: Advance Care Planningmentioning

confidence: 99%

Palliative care in residential aged care facilities

Parker

2010

Progress in Palliative Care

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“…10 Nair et al examined the process of advance care planning and the prevalence of advance directives in 88 residential aged care facilities in New South Wales. 11 Directors of care in the facilities were asked to indicate what formal or informal processes were available for residents' decision-making, including living wills, cardiopulmonary resuscitation (CPR) orders and enduring guardian or a formal guardian appointed by the Guardianship Board. In 10.6% of cases no clear process for medical decision-making was documented in the medical notes.…”

Section: Advance Care Planning In Residential Aged Care Facilitiesmentioning

confidence: 99%

“…These results indicate that while the formal process does not appear to be happening, an informal process is occurring. 11 In the United States (US), there is legislative support for advance directives, yet the majority of competent and incompetent residents lack a clear process for decision-making. Canadian research conducted on the last 48 hours of life of residents dying in longterm care facilities found that advance directives were not found in 67% of charts.…”

Section: Advance Care Planning In Residential Aged Care Facilitiesmentioning

confidence: 99%

Documenting end of life decisions in residential aged care facilities in South Australia

Brown

Grbich

Maddocks

et al. 2005

Australian and New Zealand Journal of Public Health

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Objective: This research examined the provision of palliative care for residents with a non‐cancer diagnosis including the use of advance directives and advance care planning as part of palliative care policies in residential aged care facilities in South Australia. There are no guidelines for recording residents' wishes if they are no longer competent. Methods: Stage 1 involved a survey of 90 randomly selected aged care facilities. Stage 2 involved case studies of 69 residents, appropriate for palliative care, from 17 facilities and interviews with 15 directors of care. Results: Most residential aged care facilities used forms to record residents' wishes about end of life care, but there was little consistency. Some had no palliative care policy and few facilities required a formal advance directive. Not all residents had formally appointed a proxy. Conclusions: Residential aged care facilities should be required to develop and implement a palliative care policy acknowledging the Accreditation Standards and State legislation and including a simple tool for advance care planning. Case conferencing could assist in discussing and documenting the resident's wishes. Public education is essential to increase community and professional awareness in order to promote empowerment for the increasing number of older people who will die in residential aged care facilities.

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Advance care planning in residential care

Abstract: Advanced directives are infrequently used in residential care. Further qualitative and quantitative studies are warranted to explore current processes of decision making.

Cited by 49 publications

References 19 publications

Quality of advance care planning policy and practice in residential aged care facilities in Australia

Quality of advance care planning policy and practice in residential aged care facilities in Australia

Palliative care in residential aged care facilities

Documenting end of life decisions in residential aged care facilities in South Australia

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