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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Prevalence, perceived barriers and sociodemographic correlates of advance care planning in a sample of outpatients

Elise Mansfield A B C E , Sarah Jeong B D , Amy Waller A B C and Sally Chan B D
+ Author Affiliations
- Author Affiliations

A Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.

B Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.

C Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.

D School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.

E Corresponding author. Email: Elise.Mansfield@newcastle.edu.au

Australian Journal of Primary Health 26(1) 76-80 https://doi.org/10.1071/PY19096
Submitted: 23 May 2019  Accepted: 20 September 2019   Published: 23 December 2019

Abstract

This study aimed to examine the prevalence and perceived barriers to uptake of advance care planning (ACP), including appointment of an enduring guardian (EG) and completion of an advance care directive (ACD) among Australian adults attending hospital outpatient clinics. Sociodemographic correlates of not completing ACP were also assessed. A cross-sectional survey exploring the uptake of ACP was conducted with outpatients and their accompanying persons aged >18 years (n = 191) at one regional hospital in New South Wales, Australia. Rates of completion of an ACD and appointment of an EG were 20% (n = 37) and 35% (n = 67) respectively. The most common reason for non-completion of an ACD and not appointing an EG was: ‘didn’t think I needed this’. Younger age was associated with not having appointed an EG (OR 3.8, 95% CI 1.2–12.1, P = 0.02). No sociodemographic characteristics were significantly associated with non-completion of ACDs. Uptake of ACP is suboptimal among outpatients. Community-based healthcare providers are well positioned to promote ACP with outpatients.

Additional keywords: health services, health services research, palliative care.


References

Australian Government Department of Health and Ageing (2011) A National Framework for Advance Care Directives. Commonwealth of Australia, Canberra, ACT, Australia.

Australian Institute of Health and Welfare (2018) Non-admitted patient care 2016–17: Australian hospital statistics. AIHW, Canberra, ACT, Australia.

Beck B, Bray JE, Cameron PA, Cooper JD, Gabbe BJ (2016) Trends in severe traumatic brain injury in Victoria, 2006–2014. The Medical Journal of Australia 204, e1–e6.
Trends in severe traumatic brain injury in Victoria, 2006–2014.Crossref | GoogleScholarGoogle Scholar |

Bradley SL, Woodman RJ, Tieman JJ, Phillips PA (2014) Use of advance directives by South Australians: results from the Health Omnibus Survey Spring 2012. The Medical Journal of Australia 201, 467–469.
Use of advance directives by South Australians: results from the Health Omnibus Survey Spring 2012.Crossref | GoogleScholarGoogle Scholar | 25332034PubMed |

Brinkman-Stoppelenburg A, Rietjens JA, Heide A (2014) The effects of advance care planning on end-of-life care: a systematic review. Palliative Medicine 28, 1000–1025.
The effects of advance care planning on end-of-life care: a systematic review.Crossref | GoogleScholarGoogle Scholar | 24651708PubMed |

Commonwealth of Australia (2012) Community Affairs References Committee: palliative care in Australia. Australian Government, Canberra, ACT, Australia.

Heyland DK, Barwich D, Pichora D, Dodek P, Lamontagne F, You JJ, Tayler C, Porterfield P, Sinuff T, Simon J (2013) Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA Internal Medicine 173, 778–787.
Failure to engage hospitalized elderly patients and their families in advance care planning.Crossref | GoogleScholarGoogle Scholar | 23545563PubMed |

Jeong SYS, Higgins I, McMillan M (2011) Experiences with advance care planning: nurses’ perspective. International Journal of Older People Nursing 6, 165–175.
Experiences with advance care planning: nurses’ perspective.Crossref | GoogleScholarGoogle Scholar |

Jeong S, Ohr S, Pich J, Saul P, Ho A (2015) ‘Planning ahead’ among community-dwelling older people from culturally and linguistically diverse background: a cross-sectional survey. Journal of Clinical Nursing 24, 244–255.
‘Planning ahead’ among community-dwelling older people from culturally and linguistically diverse background: a cross-sectional survey.Crossref | GoogleScholarGoogle Scholar | 25041247PubMed |

Luckett T, Spencer L, Morton RL, Pollock CA, Lam L, Silvester W, Sellars M, Detering KM, Butow PN, Tong A (2017) Advance care planning in chronic kidney disease: a survey of current practice in Australia. Nephrology (Carlton, Vic.) 22, 139–149.
Advance care planning in chronic kidney disease: a survey of current practice in Australia.Crossref | GoogleScholarGoogle Scholar |

McCarthy J, Weafer J, Loughrey M (2010) Irish views on death and dying: a national survey. Journal of Medical Ethics 36, 454–458.
Irish views on death and dying: a national survey.Crossref | GoogleScholarGoogle Scholar | 20663762PubMed |

Molloy DW, Guyatt GH, Russo R, Goeree R, O’Brien BJ, Bedard M (2000) Systematic implementation of an advance directive program in nursing homes: a randomized controlled trial. Journal of the American Medical Association 283, 1437–1444.
Systematic implementation of an advance directive program in nursing homes: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 10732933PubMed |

NSW Ministry of Health (2013) Advance planning for quality care at end of life: action plan 2013–2018. (NSW Ministry of Health: North Sydney, NSW, Australia) Available at http://www.health.nsw.gov.au/patients/acp/Publications/acp-plan-2013-2018.pdf [Verified 23 November 2018]

Peck V, Valiani S, Tanuseputro P, Mulpuru S, Kyeremanteng K, Fitzgibbon E, Forster A, Kobewka D (2018) Advance care planning after hospital discharge: qualitative analysis of facilitators and barriers from patient interviews. BMC Palliative Care 17, 127
Advance care planning after hospital discharge: qualitative analysis of facilitators and barriers from patient interviews.Crossref | GoogleScholarGoogle Scholar | 30518345PubMed |

Prendergast TJ (2001) Advance care planning: pitfalls, progress, promise. Crit Care Med 29, N34–9.
Advance care planning: pitfalls, progress, promise.Crossref | GoogleScholarGoogle Scholar | 11228571PubMed |

Rao JK, Anderson LA, Lin F-C, Laux JP (2014) Completion of advance directives among US consumers. American Journal of Preventive Medicine 46, 65–70.
Completion of advance directives among US consumers.Crossref | GoogleScholarGoogle Scholar | 24355673PubMed |

Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ, Matlock DD, Rietjens JAC, Korfage IJ, Ritchie CS, Kutner JS, Teno JM, Thomas J, McMahan RD, Heyland DK (2017) Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. J Pain Symptom Manage 53, 821–832.e1.
Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel.Crossref | GoogleScholarGoogle Scholar | 28062339PubMed |

Waller A, Dodd N, Tattersall MHN, Nair B, Sanson-Fisher R (2017) Improving hospital-based end of life care processes and outcomes: a systematic review of research output, quality and effectiveness. BMC Palliative Care 16, 34
Improving hospital-based end of life care processes and outcomes: a systematic review of research output, quality and effectiveness.Crossref | GoogleScholarGoogle Scholar | 28526095PubMed |

Waller A, Douglas C, Sanson-Fisher R, Zdenkowski N, Pearce A, Evans T, Walsh J (2018) Dances with denial: have medical oncology outpatients conveyed their end-of-life wishes and do they want to? Journal of the National Comprehensive Cancer Network : JNCCN 16, 498–505.
Dances with denial: have medical oncology outpatients conveyed their end-of-life wishes and do they want to?Crossref | GoogleScholarGoogle Scholar | 29752324PubMed |

White B, Tilse C, Wilson J, Rosenman L, Strub T, Feeney R, Silvester W (2014) Prevalence and predictors of advance directives in Australia. Internal Medicine Journal 44, 975–980.
Prevalence and predictors of advance directives in Australia.Crossref | GoogleScholarGoogle Scholar | 25109226PubMed |

White BP, Willmott L, Tilse C, Wilson J, Ferguson M, Aitken J, Dunn J, Lawson D, Pearce A, Feeney R (2019) Prevalence of advance care directives in the community: a telephone survey of three Australian States. Internal Medicine Journal 49, 1261–1267.
Prevalence of advance care directives in the community: a telephone survey of three Australian States.Crossref | GoogleScholarGoogle Scholar | 30785233PubMed |