Understanding of advance care planning in primary care: a gap analysis
Josephine Chow
A B C D E * , Ann Harley F , Danielle Ni Chroinin A , Friedbert Kohler A D G , Janeane Harlum A , Kim Jobburn A , Pamela Keech A , Rachael Williams A , Susan Fraser A and Ken Hillman A D
+ Author Affiliations
- Author Affiliations
A South Western Sydney Local Health District, Sydney, NSW, Australia.
B Clinical Stream Office, Don Everett Building, Locked Bag 7103, BC 1871, Liverpool, NSW 2170, Australia.
C University of Sydney, Sydney, NSW, Australia.
D University of New South Wales, Sydney, NSW, Australia.
E Western Sydney University, Sydney, NSW, Australia.
F South Western Sydney Primary Health Network, Sydney, NSW, Australia.
G HammodCare, Sydney, NSW, Australia.
* Correspondence to: Josephine.Chow@sswahs.nsw.gov.au, Josephine.chow@health.nsw.gov.au
Australian Journal of Primary Health 28(4) 344-349 https://doi.org/10.1071/PY21253
Submitted: 10 July 2021 Accepted: 28 February 2022 Published: 24 May 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University.
Abstract
Background: Although primary care is a well suited context for conducting advance care planning (ACP), there are many barriers to initiating discussions regarding future health preference and end-of-life conversations.
Methods: This qualitative study conducted 30 detailed individual interviews with senior administrators, medical and nurse practitioners of a local health district, NSW Ambulance, e-Health NSW, general practitioners and practice nurses to find out about barriers to ACP in South Western Sydney.
Results: Thematic analysis was conducted on the interviews. Six major themes were identified: Prevalence; Empowerment of roles and responsibilities; Lack of training/knowledge/confidence; Fragmentation of care; Patient/family readiness; and Prognostication. Half of the participants were willing to use a prognostic tool to identify when a patient was likely to be at the end of their life and provide a prompt to initiate ACP.
Conclusion: In addition to addressing training and acknowledging resource constraints, these findings suggest that if a prognostic tool was validated and practical in a primary care setting, it may provide valuable assistance to encourage everyone in society to begin discussing this issue and completing ACP.
Keywords: advance care directive, advance care planning, community, end of life, general practice, model of care, primary care, screening tool.
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