A whole-of-community program of advance care planning for end-of-life care
Ian A. Scott A B * , Liz Reymond C D , Xanthe Sansome C and Leyton Miller CA Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia.
B School of Clincial Medicine, University of Queensland, Qld, Australia.
C Eight Mile Plains Community Health, 51 McKechnie Drive, Eight Mile Plains, Qld 4113, Australia.
D School of Public Health, Griffith School of Medicine, Qld, Australia.
Australian Health Review 46(4) 442-449 https://doi.org/10.1071/AH22099
Submitted: 6 April 2022 Accepted: 15 June 2022 Published: 12 July 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Since 2015 a whole-of-community program to promote advance care planning (ACP) within one Queensland Hospital and Health Service (HHS) catchment has spread statewide, financed by Queensland Health (QH) agencies and led by the Statewide Office of Advance Care Planning (SOACP). The program aims to identify ACP-eligible patients, invite and finalise ACP discussions, and ensure documented care preferences are easily retrievable by clinicians to guide future care if a person loses capacity. The SOACP established a digital infrastructure whereby quality-audited ACP documents are uploaded to a software platform accessible to all QH clinicians, private medical specialists, ambulance paramedics, general practitioners (GPs), and registered nurses, including those in residential aged care facilities (RACFs). The SOACP also hosts a website providing resources for clinicians and patients, delivers educational events and mentorship to GPs and hospital and RACF staff, and employs ACP facilitators working across all QH HHSs. The program has seen yearly increases in the numbers of ACP documents uploaded from around the state, with up to 79% of eligible patients in some hospitals receiving ACP, significant ACP uptake in RACFs, and acceptance by GPs to engage in ACP. Audits reveal high concordance between stated preferences and hospital care received, and ACP patients, compared to matched non-ACP controls, more frequently die out of hospital, have fewer inpatient days during their last 6 months of life, and receive less invasive care, with similar results seen among same-patient cohorts post-ACP. Barriers and enablers to ACP have been identified which will inform program evolution.
Keywords: advance care planning, barriers, concordance, documentation, enablers, end-of-life care, patient preferences, whole-of-community program.
References
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