Advance care planning in palliative care: a national survey of health professionals and service managers
Marcus Sellars A , William Silvester A D , Malcolm Masso B and Claire E. Johnson CA Respecting Patient Choices Program, Austin Hospital, PO Box 5555, Heidelberg, Vic. 3084, Australia. Email: marcus.sellars@austin.org.au
B Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, iC Enterprise 1, Innovation Campus, University of Wollongong, Wollongong, NSW 2522, Australia. Email: mmasso@uow.edu.au
C Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, M507, 35 Stirling Hwy, Crawley, WA 6009, Australia. Email: claire.johnson@uwa.edu.au
D Corresponding author. Email: william.silvester@austin.org.au
Australian Health Review 39(2) 146-153 https://doi.org/10.1071/AH14118
Submitted: 23 July 2014 Accepted: 27 October 2014 Published: 22 January 2015
Journal Compilation © AHHA 2015
Abstract
Objective To identify the attitudes, knowledge and practices regarding advance care planning (ACP) in palliative care.
Methods A nationwide online survey was distributed to Australian palliative care services associated with the Palliative Care Outcomes Collaboration (n = 105). Seventy-three health professionals (HPs) and 59 service managers completed the survey.
Results Regarding ACP, 51% of service managers reported relevant policies and procedures were in place in their service and 44% included ACP in job descriptions. Most HPs were confident in undertaking ACP, including initiating discussions with patients and complying with documents; however, only 44% reported receiving ACP specific training. Although 58% of HPs reported having conversations about ACP with more than 11 patients in the past 6 months, only 44% of managers report that it is offered to most patients. Thirty per cent of HPs were aware of others not adhering to patient wishes in the past 6 months and only 43% of HPs (and 37% of managers) believed ACP is done well within their service.
Conclusions This first national survey examining ACP in palliative care services demonstrates there is a need to improve systems to support ACP and to understand circumstances in which ACP wishes are not followed.
What is known about the topic? ACP is increasingly recognised as an important part of care of people in hospital and community settings. However, currently there is no empirical evidence about the national uptake and quality of ACP in palliative care settings specifically.
What does this paper add? This nationwide survey shows improvements on past small-scale research showing that ACP is supported by palliative care health professionals; however, the organisational ACP processes and systems did not support best practice in this regard.
What are the implications for practitioners? Palliative care organisations should incorporate ACP systems (including greater access to ACP policies and guidelines) that support health professionals to complete ACP with clients who want to. Greater access to support, such as ACP training and resources, would assist with development of ACP documentation and adherence.
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