Understanding how advance care planning is approached in the residential aged care setting: A continuum model of practice as an explanatory device

Shanley, Christopher; Whitmore, Elizabeth; Khoo, Angela; Cartwright, Colleen M; Walker, Amanda; Cumming, Robert G.

doi:10.1111/j.1741-6612.2009.00383.x

Cited by 31 publications

(48 citation statements)

References 18 publications

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“…For example, only half of the facilities reported having an ACP-specific policy at pre-implementation and none of the existing documentation submitted by participating RACFs adequately covered all domains required for best practice. These findings are also in line with other Australian studies 4 28 30 33 34 39…”

Section: Discussionsupporting

confidence: 93%

“…This paper presents the key findings of the pre-implementation evaluation; post-implementation changes to these findings will be reported in a future paper. We hypothesised that although pre-implementation ACP awareness and practice within the project facilities may be higher than previously reported, in line with previous research in this area,4 28 30 33 34 the quality of ACP practices would be highly variable.…”

supporting

confidence: 63%

“…A number of studies have examined aspects of ACP in Australia, including guidelines for implementing ACP in Australian healthcare settings,1 4 29 30 the roles of different health practitioners in supporting ACP,31–34 and the outcomes of a randomised controlled trial in which elderly patients were allocated to receive usual care or facilitated ACP 6. In the specific context of Australian residential aged care facilities (RACFs), development of advance care plans may or may not be part of the institution's policy, and in those settings where the importance of the ACP process is recognised, the quality of processes and instruments developed has been found to be variable and often questionable 4 28 30 33 34. More recently, the need for the provision of quality ACP within Australian residential aged care settings has been highlighted during major healthcare reviews35 and in federal strategies 36.…”

mentioning

confidence: 99%

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Quality of advance care planning policy and practice in residential aged care facilities in Australia

Silvester

Fullam

Parslow

et al. 2012

BMJ Support Palliat Care

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ObjectivesTo assess existing advance care planning (ACP) practices in residential aged care facilities (RACFs) in Victoria, Australia before a systematic intervention; to assess RACF staff experience, understanding of and attitudes towards ACP.DesignSurveys of participating organisations concerning ACP-related policies and procedures, review of existing ACP-related documentation, and pre-intervention survey of RACF staff covering their role, experiences and attitudes towards ACP-related procedures.Setting19 selected RACFs in Victoria.Participants12 aged care organisations (representing 19 RACFs) who provided existing ACP-related documentation for review, 12 RACFs who completed an organisational survey and 45 staff (from 19 RACFs) who completed a pre-intervention survey of knowledge, attitudes and behaviour.ResultsFindings suggested that some ACP-related practices were already occurring in RACFs; however, these activities were inconsistent and variable in quality. Six of the 12 responding RACFs had written policies and procedures for ACP; however, none of the ACP-related documents submitted covered all information required to meet ACP best practice. Surveyed staff had limited experience of ACP, and discrepancies between self reported comfort, and levels of knowledge and confidence to undertake ACP-related activities, indicated a need for training and ongoing organisational support.ConclusionsSurveyed organisations â policies and procedures related to ACP were limited and the quality of existing documentation was poor. RACF staff had relatively limited experience in developing advance care plans with facility residents, although attitudes were positive. A systematic approach to the implementation of ACP in residential aged care settings is required to ensure best practice is implemented and sustained.

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Section: Discussionsupporting

confidence: 93%

supporting

confidence: 63%

mentioning

confidence: 99%

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Quality of advance care planning policy and practice in residential aged care facilities in Australia

Silvester

Fullam

Parslow

et al. 2012

BMJ Support Palliat Care

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“…They also comprise a wide range of ages [4, 11, 49–55] and conditions such as cancer [3, 4, 19, 24, 25, 56–62], terminal respiratory diseases [63–66], cardiac failure [26, 67–70], profound intellectual and physical disability, and advanced dementia [1, 47, 50, 62, 71, 72]. These patients pose a challenge in the ED because the majority appear not to have access to palliative care options, in particular those with non-cancer conditions.…”

Section: Introductionmentioning

confidence: 99%

“…These patients pose a challenge in the ED because the majority appear not to have access to palliative care options, in particular those with non-cancer conditions. [73] Patients are managed in the ED when palliative management at home would have been more appropriate if a transition from active to palliative management had been made earlier [55, 74–76]. …”

Section: Introductionmentioning

confidence: 99%

A Literature Review on Care at the End-of-Life in the Emergency Department

Forero

McDonnell

Gallego

et al. 2012

Emergency Medicine International

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The hospitalisation and management of patients at the end-of-life by emergency medical services is presenting a challenge to our society as the majority of people approaching death explicitly state that they want to die at home and the transition from acute care to palliation is difficult. In addition, the escalating costs of providing care at the end-of-life in acute hospitals are unsustainable. Hospitals in general and emergency departments in particular cannot always provide the best care for patients approaching end-of-life. The main objectives of this paper are to review the existing literature in order to assess the evidence for managing patients dying in the emergency department, and to identify areas of improvement such as supporting different models of care and evaluating those models with health services research. The paper identified six main areas where there is lack of research and/or suboptimal policy implementation. These include uncertainty of treatment in the emergency department; quality of life issues, costs, ethical and social issues, interaction between ED and other health services, and strategies for out of hospital care. The paper concludes with some areas for policy development and future research.

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Use of advance care directives for individuals with dementia living in residential accommodation: A descriptive survey

et al. 2019

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Background: Background: End-of-life decision-making for individuals living with a dementia needs to be addressed because as dementia progresses, individuals need support to make decisions about their health care, living arrangements and end-of-life care changes. Advance care directives (ACDs) provide an opportunity for individuals living with a dementia to communicate their wishes about these important issues. Aim: Aim: The aim of this study was to understand how Australian registered nurses (RNs) use ACDs for individuals with a dementia living in residential accommodation. Methods: Methods: Two hundred and thirty eight RNs working in Australian residential accommodation were recruited via social media, professional organisations and organisations providing residential accomodation. Respondents completed an online survey delivered via Survey Monkey. Findings: Findings: 59.7% of respondents reported commencing discussions around ACDs within the first month of individuals living with a dementia relocating to residential accommodation. However, 42.4% never or rarely completed ACDs. Only 59.3% stated that ACDs for individuals living with a dementia were always or often regularly reviewed. 53.8% identified that ACDs were always adhered to when an individuals' circumstances changed. 62.6% felt that understanding among families about ACDs was sometimes, or often, a barrier to using ACDs. Conclusion: Conclusion: The implementation of ACDs in Australian residential accommodation for those living with a dementia remains sub-optimal. This study has demonstrated that ACD documentation and policies describing how they should be used exist, but gaps remain around the practical implementation of ACDs. Strategies to promote communication and collaboration between residential facilities, general practitioners and carers / families could also assist in providing cohesive, high quality care.

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Understanding how advance care planning is approached in the residential aged care setting: A continuum model of practice as an explanatory device

Abstract: A continuum model of practice is proposed that describes four broad approaches to practice under the domains of initiation, scope, follow-up and documentation of ACP as well as the organisational leadership adopted around ACP.

Cited by 31 publications

References 18 publications

Quality of advance care planning policy and practice in residential aged care facilities in Australia

Quality of advance care planning policy and practice in residential aged care facilities in Australia

A Literature Review on Care at the End-of-Life in the Emergency Department

Use of advance care directives for individuals with dementia living in residential accommodation: A descriptive survey

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