The advance care planning nurse facilitator: describing the role and identifying factors associated with successful implementation
Jeremy Rogers A , Charlotte Goldsmith A , Craig Sinclair B and Kirsten Auret B CA University of Western Australia, Hackett Avenue, Crawley, Perth, WA 6009, Australia.
B Rural Clinical School of Western Australia (Albany), University of Western Australia (Albany Centre), Stirling Terrace, Albany, WA 6330, Australia.
C Corresponding author. Email: kirsten.auret@rcswa.edu.au
Australian Journal of Primary Health 25(6) 564-569 https://doi.org/10.1071/PY19010
Submitted: 21 January 2019 Accepted: 11 July 2019 Published: 19 November 2019
Abstract
Advance care planning (ACP) has been shown to improve end-of-life care, yet uptake remains limited. Interventions aimed at increasing ACP uptake have often used a ‘specialist ACP facilitator’ model. The present qualitative study appraised the components of an ACP facilitator intervention comprising nurse-led patient screening and ACP discussions, as well as factors associated with the successful implementation of this model in primary care and acute hospital settings across rural and metropolitan Western Australia. Semistructured interviews were undertaken with 17 health professionals who were directly or indirectly involved in the facilitator ACP intervention among patients with severe respiratory disease. Additional process data (nurse facilitator role description, agreements with participating sites) were used to describe the nurse facilitator role. The interview data identified factors associated with successful implementation, including patient factors, health professional factors, ACP facilitator characteristics and the optimal settings for the intervention. The primary care setting was seen as most appropriate, and time limitations were a key consideration. Factors associated with successful implementation included trusting relationships between the nurse facilitator and referring doctor, as well as opportunities for meaningful encounters with patients. This study suggests a model of ACP nurse facilitation based in primary care may be an acceptable and effective method of increasing ACP uptake.
Additional keywords: general practitioner, nursing, respiratory disease.
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