Advance care planning in palliative care: a national survey of health professionals and service managers

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.

Palliative care health professionals’ experiences of caring for patients with advance care directives

“…Further details of the survey and results from the closed questions are provided elsewhere. 6 Consent was implied by completion of the online questionnaire. Ethics approval was obtained from the University of Wollongong/Illawarra Shoalhaven Local Health District Human Research Ethics Committee (Approval no.…”

“…7 However, despite the reported benefits, our knowledge of the use of ACDs in the clinical setting is limited, particularly within specialist palliative care services. 6 Specifically, little is known about how ACDs are implemented in palliative care or how advance care plans affect palliative care health professionals' experiences of caring for people at the end of life, especially in the Australian health context. The aim of the present study was to explore service providers' perceptions and experiences of advance care planning and the use of ACDs in Australian palliative care services.…”

“…Advance care planning may also be undertaken by people who have a life-limiting illness or when deterioration is imminent. 6 The recent systematic review by Lovell and Yates explored the contextual factors influencing the uptake of advance care planning and development of ACDs. 7 However, despite the reported benefits, our knowledge of the use of ACDs in the clinical setting is limited, particularly within specialist palliative care services.…”

Project to improve storage, access and incorporation of advance care plans in a regional Australian hospital

“…As over 50% of Australians die in hospitals, policy and standards encourage hospitals to support ACP [1][2][3][4][5] to improve the quality of end-of-life (EOL) care. [6][7][8][9][10] However, a 2014 review found that ACP documentation is often limited, inaccessible and not associated with improved care quality. Health care improvement organisations advocate that hospitals develop systems to elicit, store and act on patient preferences in a dependable way.…”

Advance Care Planning: Understanding Clinical Routines and Experiences of Interprofessional Team Members in Diverse Health Care Settings

“…Previous research surveys on ACP have focused on a single setting (eg, inpatient hospital or primary care), 6,7 a single group of health care providers (eg, only physicians or only palliative care providers), 5,8 specific diseases such as cancer or heart failure, 9 or were conducted outside the United States. 7,10 …”