Communication of advance care planning decisions: a retrospective cohort study of documents in general practice

Abstract

Background: Doctors, particularly general practitioners, play a significant role in assisting patients to create advance care plans. When medically indicated, these documents are important tools to promote congruence between endof-life care and patient's personal preferences. Despite this, little is known regarding the availability of these documents in hospitals. The aim of this study was to identify the proportion of people who died in hospital without an advance care plan and how many of these had advance care planning (ACP) documents in their general practice records. Methods: A retrospective cohort study was conducted of patient hospital records with manual linkage to general practice records. The large regional hospital in Victoria, Australia has a catchment population in excess of 300,000 people. The study sample was patients aged 75 years and over who died in the hospital between 1 January 2016 and 31 December 2017. The hospital records of these patients were examined to identify those which did not have a system alert for ACP documents on the file. Alerted ACP documents were limited to those legislated in the state of Victoria: advance care plan, Enduring Power of Attorney (Medical Treatment) or Enduring Power of Guardianship. Where no ACP document system alert was found in the hospital record, the patient's nominated general practice was consented to participate and the corresponding general practice record was examined. Data were analysed using descriptive statistics. Results: Of the 406 patients who died in hospital, 76.1% (309) did not have a system alert for any ACP document. Of the 309 hospital records without a system alert, 144 (46.7%) corresponding general practice records were examined. Of these, 14.6% included at least one ACP document, including four advance care plans, that were not available in hospital. Conclusions: Unless ACP documents are consistently communicated from general practice, patient's preferences may be unknown during end-of-life care. It is important that both doctors and patients are supported to use connected electronic health records to ensure that documents are readily available to healthcare staff when they are required.

Palliative Care Within the Primary Health Care Setting in Australia: A Scoping Review

“…Conversations usually start when a patient initiates them, when they are included in routine care, when they discuss prognosis or less directly inquire about the patients feelings about death [ 31 ]. GPs commit time and resource to assist their patients to create an end-of-life care plan [ 32 ], however, at times the end-of-life care plan is not explicitly articulated and discussed, so an informal care plan is developed gradually without discussing these plans with the patient [ 33 ].…”

Quality of end-of-life care in general practice – a pre–post comparison of a two-tiered intervention

“…It is crucial for health care providers to be confident in their decision making around ACP, in order to ensure a high quality of care [ 40 , 41 ]. Advance care plans aim at bringing patients’ preferences in line with EoLC [ 42 ]. Accordingly, they may contribute to optimising the quality of EoLC [ 41 ].…”

“…Accordingly, they may contribute to optimising the quality of EoLC [ 41 ]. However, ACP documents are not regularly available when needed, and several barriers to ACP have been acknowledged [ 18 , 42 , 43 ]. In particular, patients might avoid talking about EoLC for various reasons (e.g.…”

Quality Of End-Of-Life Care In General Practice – A Pre–Post Comparison Of A Two-Tiered Intervention

“…It is crucial for health care providers to be con dent in their decision making around ACP, in order to ensure a high quality of care [31,32]. Advance care plans aim at bringing patients' preferences in line with EoLC [33]. Accordingly, they may contribute to optimising the quality of EoLC [32].…”

“…Accordingly, they may contribute to optimising the quality of EoLC [32]. However, ACP documents are not regularly available when needed, and several barriers to ACP have been acknowledged [33][34][35]. In particular, patients might avoid talking about EoLC for various reasons (e.g.…”