Prevalence of advance care planning practices among people with chronic diseases in hospital and community settings: a retrospective medical record audit

Abstract

Background Advance Care Planning (ACP) enables healthcare professionals to embrace the important process where patients think about their values in life and goals for health care, and discuss their future health care preferences with family members for a time when they are not able to make health care decisions. Despite the promotion of ACP last two decades, and well-known benefits of ACP and a written Advance Care Directive (ACD), they are still underutilised in Australia and across the world. Previous studies have provided some insights, however, an uptake of ACP and prevalence of ACDs in community settings is rarely reported. Methods The aim of this study was to determine the uptake of ACP and prevalence of ACDs among people with chronic diseases in hospital and community settings. A retrospective medical record audit of eligible patients looking for evidence of ACP was conducted in 16 research sites in eight hospital and eight community care settings. Participants included those who were admitted to one of the research sites, and who were aged 18 years and over with at least one of nine nominated chronic diseases. The primary outcome measures included the number of patients with evidence of ACP through the following practices: completion of an ACD, appointment of an Enduring Guardian (EG), or completion of a resuscitation plan. Results The overall prevalence of ACD was 2.8% (n = 28) out of 1006 audited records, and only 10 (1%) of them were legally binding. The number of EGs appointed was 39 (3.9%) across the sites. A total of 151 (15.4%) resuscitation plans were found across the eight hospital sites. 95% (n = 144) of the resuscitation plans indicated ‘Not-for-resuscitation’. Conclusions The uptake of ACP is very low. Current medical recording system reveals the challenges in ACP lie in the process of storage, access and execution of the ACDs. Given that having an ACD or Enduring Guardian in place is only useful if the treating physician knows how and where to access the information, it has implications for policy, information system, and healthcare professionals’ education. Trial registration The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx

Efficacy of Normalisation of Advance Care Planning (NACP) for people with chronic diseases in hospital and community settings: a quasi-experimental study

“…However, various terms appear with variations in jurisdictional legislation, for example, an EG in Australia and ‘Lasting Power of Attorney for Health and Welfare’ in the UK [ 36 ], and ‘a legal proxy’ in German [ 37 ], even with a consensus that ACP includes ACDs and the appointment of a proxy decision maker [ 38 ]. The challenges with the lack of uniform term across the world include misunderstanding of the responsibility and legality, and underreporting or misreporting of the prevalence of EG [ 35 , 39 ]. This study specified the definition of an EG in Australian context (See Supplementary file 2 ) to increase clarity and accuracy of the results.…”

Preferences for end‐of‐life care: A cross‐sectional survey of Chinese frail nursing home residents

“…Early planning is particularly important for older adults with frailty as they are likely to develop adverse outcomes and deteriorate unexpectedly (Clegg et al, 2013; Covinsky et al, 2003). Yet, ACP continues to be underutilized in long‐term care settings (De Gendt et al, 2013; Jeong et al, 2021; Knight et al, 2020).…”

Part of the solution: A survey of community organisation perspectives on barriers and facilitating actions to Advance Care Planning in British Columbia, Canada

“…4 Low rates of ACP engagement are unfortunately not unique to Canada. 5 A recent Australian survey found that only 15% of adults had completed ACP documentation, 6 while studies in Northern Ireland and Singapore found rates of having had an ACP discussion to be 7% and 12.5%, respectively. 7,8 ACP education and conversations have generally been restricted to the health system, but in a recent study, healthcare providers reported insufficient time and their own lack of knowledge as significant barriers.…”