Study protocol to investigate the efficacy of normalisation of Advance Care Planning (ACP) for people with chronic diseases in acute and community settings: a quasi-experimental design

Abstract

Background Advanced care planning (ACP) is a process that involves thinking about what medical care one would like should individuals be seriously ill and cannot communicate decisions about treatment for themselves. The literature indicates that ACP leads to increased satisfaction from both patients and healthcare professionals. Despite the well-known benefits of ACP, it is still underutilised in Australia. Methods The aim of this study is to investigate the effects of normalising ACP in acute and community settings with the use of specially trained normalisation agents. This is a quasi-experimental study, involving 16 sites (8 intervention and 8 control) in two health districts in Australia. A minimum of total 288 participants will be recruited (144 intervention, 144 control). We will train four registered nurses as normalisation agents in the intervention sites, who will promote and facilitate ACP discussions with adult patients with chronic conditions in hospital and community settings. An audit of the prevalence of ACP and Advanced Care Directives (ACDs) will be conducted before and after the 6-month intervention period at the 16 sites to assess the effects of the ACP service delivered by these agents. We will also collect interview and survey data from patients and families who participate, and healthcare professionals who are involved in this service to capture their experiences with ACP. Discussion This study will potentially contribute to better patient outcomes with their health care services. Completion of ACDs will allow patients to express their wishes for care and receive the care that they wish for, as well as ease their family from the burden of making difficult decisions. The study will contribute to development of a new best practice model to normalise ACP that is sustainable and transferable in the processes of: 1) initiation of conversation; 2) discussion of important issues; 3) documentation of the wishes; 4) storage of the documented wishes; and 5) access and execution of the documented wishes. The study will generate new evidence on the challenges, strategies and benefits of normalising ACP into practice in acute and community settings. Trial registration This project has been approved by the Hunter New England Human Research Ethics Committee (Approval No. 17/12/13/4.16). It has also been retrospectively registered on 3 October 2018 with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246 ). This study will operate in accordance with the National Health and Medical Research Council’s National Statement on Ethical Conduct in Human Research (2007) and the CPMP/ICH Note for Guidance on Good Clinical Practice.

Prevalence of advance care planning practices among people with chronic diseases in hospital and community settings: a retrospective medical record audit

“…It is timely that a recent systematic review [ 33 ] suggested that there are preconditions in multiple domains at micro, meso and macro levels to implement ACP successfully and as such it requires a whole-system approach. The findings of this retrospective audit will inform the main study [ 28 ] which embedded multiple mechanisms to implement a normalised ACP service.…”

“…All analyses were performed using Stata Version 15.0 (StataCorp LP, College Station, TX, USA). Due to the extremely low evidence of ACP, multi-level regression analysis planned in the study protocol [ 28 ] was not conducted but descriptive statistics were used to summarise the data as recommended by a statistician.…”

“…The aim of the current study was to examine the prevalence of ACP in two Local Health Districts (LHDs) in NSW, Australia prior to a trial of normalised ACP service which was implemented for people with chronic conditions in hospital and community settings. The trial was a quasi-experimental study and the study protocol is reported elsewhere [ 28 ]. For this study, the chronic diseases included cancer, chronic kidney disease, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, dementia, diabetes, frailty and hypertension and are aligned with special ACP needs in the NSW Action Plan 2013–2018 [ 13 ].…”

Prevalence of Advance Care Planning Practices Among People with Chronic Diseases in Hospital and Community Settings: A Quasi-Experimental Design

“…In summary, storage of ACP related documents is inconsistent and does not facilitate timely access to or execution of these documents. These challenges are noted in other studies [15,18]. One study by Cheang et al [20] revealed that out of 100 patients, they could not nd any record of ACDs in their medical les, despite 12% of patients reporting to have an ACD in place in their interview.…”

“…In 2018, a trial of normalised ACP service was implemented for people with chronic conditions in hospital and community settings in New South Wales (NSW), Australia. This was a quasi-experimental study and the study protocol is reported elsewhere [15]. A total of 16 sites across two local health districts (LHDs) (eight in each) that covered both hospital and community settings, and both government and nongovernment agencies were selected.…”