Current advance care planning practice in the Australian community: an online survey of home care package case managers and service managers

Abstract

BackgroundAdvance care planning (ACP) is the process of planning for future healthcare that is facilitated by a trained healthcare professional, whereby a person’s values, beliefs and treatment preferences are made known to guide clinical decision-making at a future time when they cannot communicate their decisions. Despite the potential benefits of ACP for community aged care clients the availability of ACP is unknown, but likely to be low. In Australia many of these clients receive services through Home Care Package (HCP) programs. This study aimed to explore current attitudes, knowledge and practice of advance care planning among HCP service managers and case managers.MethodsAn invitation to take part in a cross-sectional online survey was distributed by email to all HCP services across Australia in November 2012. Descriptive analyses were used to examine overall patterns of responses to each survey item in the full sample.Results120 (response rate 25%) service managers and 178 (response rate 18%) case managers completed the survey. Only 34% of services had written ACP policies and procedures in place and 48% of case managers had previously completed any ACP training. In addition, although most case managers (70%) had initiated an ACP discussion in the past 12 months and viewed ACP as part of their role, the majority of the conversations (80%) did not result in documentation of the client’s wishes and most (85%) of the case managers who responded did not believe ACP was done well within their service.ConclusionsThis survey shows low organisational ACP systems and support for case managers and a lack of a normative approach to ACP across Australian HCP services. As HCPs become more prevalent it is essential that a model of ACP is developed and evaluated in this setting, so that clients have the opportunity to discuss and document their future healthcare wishes if they choose to.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-015-0018-y) contains supplementary material, which is available to authorized users.

Barriers to advance care planning with patients as perceived by nurses and other healthcare professionals: A systematic review

“…The majority (ten) used a mixture of closed‐ and open‐ended questions; however, one study used purely closed questions (Sellars et al, ). Eight studies described newly developed or modified instruments (Beck et al, ; Downe‐Wamboldt et al, ; Duke & Thompson, ; Jezewski et al, ; Lipson et al, ; Sellars et al, ; Snyder et al, ; Zhou et al, ), whilst the other three used one of these eight instruments. A description of how survey instruments were developed and how validity and reliability were established is provided in Table .…”

“…Nurses rated themselves and scored highly on the more general questions about ACP/ADs including definitions and purpose (Jezewski & Feng, ; Jezewski et al, ; Lipson et al, ; Putman‐Casdorph et al, ; Scherer et al, ; Zhou et al, ). In contrast, nursing home managers and home care package case managers scored poorly and lacked confidence in their levels of knowledge (Beck et al, ; Sellars et al, ). Questions about specific legislation, whether that be national or state, were typically answered poorly by all (Beck et al, ; Downe‐Wamboldt et al, ; Jezewski & Feng, ; Jezewski et al, ; Putman‐Casdorph et al, ; Scherer et al, ; Zhou et al, ).…”

“…Overall, healthcare professionals had a positive attitude towards ACP/ADs (Downe‐Wamboldt et al, ; Duke & Thompson, ; Lipson et al, ; Sellars et al, ; Zhou et al, ) believing they were helpful (Downe‐Wamboldt et al, ; Duke & Thompson, ), valuable and worthwhile (Sellars et al, ). However, one study involving acute care and outpatient oncology nurses reported moderately negative attitudes (Putman‐Casdorph et al, ).…”

“…A participant in one study (Downe‐Wamboldt et al, ) expressed difficulty when dealing with an AD when “you don't agree with the decision.” However, three other studies (Jezewski & Feng, ; Jezewski et al, ; Scherer et al, ) found a high level of agreement for the principle that nurses should uphold patients’ decisions even if they disagree. Two studies (Downe‐Wamboldt et al, ; Putman‐Casdorph et al, ) found agreement that nurses consider ACP discussions as part of their role, whilst the studies involving home care package case managers (Sellars et al, ) and nursing home managers (Beck et al, ) found around half agreeing that it was part of their responsibilities. Interestingly, the one study which focussed on physicians found that they felt that it was patients and/or families who erect barriers to successful ACP discussions (Snyder et al, ).…”

Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients

“…Two models of ACP provision were utilised: the Facilitator model, based on previous ACP implementation in other health settings,2 18 and the Referral model, based on the findings from Australian research showing current practice includes initiation of ACP and then referral for ACP completion 17. Details of these models are outlined in table 1.…”