Current practices, barriers and enablers for advance care planning among healthcare workers of aged care facilities in western New South Wales, Australia

Abstract

Introduction: Advance care planning (ACP) and advance care directives (ACDs) play a vital role in preparing for end-of-life care. However, current literature suggests that uptake of ACP and ACDs in rural Australia is low, which may contribute to lower quality care for the older rural population, as patients' end-of-life wishes may not be recognised and acknowledged. This study aims to provide a current perspective on the attitudes and practices of healthcare workers from residential aged care facilities towards ACP and ACDs in the central west, far west and Orana regions of New South Wales, Australia. Methods: This was a mixed-methods study incorporating anonymous survey and individual interviews. Healthcare workers from 12 residential aged care facilities within the studied region completed surveys (n=109). The 40-item survey assessed participant demographics, training and experience with ACP and ACD, attitudes towards ACP and ACDs, and barriers and facilitators towards the use of ACP and ACDs in their organisation. Five participants were interviewed to explore these issues in more depth.Results: Almost three-quarters (71%) of respondents thought that ACP is necessary while almost half (48%) were involved with >5 ACDs in the past 12 months. Formal training was seen as beneficial by most (81%) but the importance of practical experience was also acknowledged. No statistically significant differences were found in attitudes between those with <5 years and those with >5 years of experience. Avoidance of unnecessary resuscitation was a consistent theme in all interviews and the potential of a nurse-led model of delivery was identified. Patient factors such as decreased capacity to make informed decisions were identified as barriers that could be circumvented by pre-emptive implementation of ACP discussion. The rural setting was identified as a facilitator due to a supportive community, which helped to mitigate barriers such as limited staffing. Conclusions: Attitudes towards ACP in rural New South Wales are highly positive. The rural setting is a facilitator to ACP, and ACDs are approached in a multidisciplinary fashion. Further training is an identified need although on-the-ground experience may be more beneficial.

Feasibility and acceptability of introducing advance care planning on a thoracic medicine inpatient ward: an exploratory mixed method study

“…In the focus groups, a debate about organising and standardising ACP conversations and documentation of these came up as a consequence of the positive impact of the project. So, despite having barriers against ACP, clinicians perceived ACP as important, as also shown by others 8 9 20 40–43. Starting up the pilot study with help from ward staff, we soon discovered problems for recruitment related to time and knowledge (table 3), and we introduced a study nurse.…”

Palliative Approach to Care Education for Multidisciplinary Staff of Long-Term Care Homes: A Pretest Post-Test Study

“…As evidenced by the study results, preparing LTC staff with a formal educational workshop may improve comfort with ACP involving residents and their family care partners; therefore, lessening the avoidance of this topic altogether and instead enhancing engagement ( Hunter et al., 2020 ; Jeong et al., 2011 ; Kaasalainen et al, 2017 ; Lam et al, 2018 ; Lin et al, 2019 ; Spacey et al, 2021 ; Sussman et al, 2017 ; Vellani, Green et al, 2022 ). Despite the benefits of having early ACP, these conversations continue to not be consistently addressed between LTC staff, residents and family care partners ( Berning et al, 2021 ; Sussman et al., 2020 ).…”

“…Despite the benefits of having early ACP, these conversations continue to not be consistently addressed between LTC staff, residents and family care partners ( Berning et al, 2021 ; Sussman et al., 2020 ). Therefore, formal educational workshops can serve as a facilitator for ACP ( Lam et al., 2018 ). Facilitating earlier ACP can benefit LTC staff, residents, and family care partners in integrating a person-centered palliative approach to care ( Zhou et al, 2022 ).…”

Organisational and advance care planning program characteristics associated with advance care directive completion: a prospective multicentre cross-sectional audit among health and residential aged care services caring for older Australians

“…Within aged care settings, regional and rural organisations had a much higher prevalence than those in metropolitan areas. Rurality is positively associated with ACP discussions [56] and may be linked to important drivers for ACP such as concerns regarding place of care and place of death, [57] however more research is required to understand this association better.…”