Improving uptake of advance care planning through education and training in a public hospital geriatric clinic.
Australia
attorney
dementia
documentation
geriatric
outpatients
patients
setting
Journal
Australasian journal on ageing
ISSN: 1741-6612
Titre abrégé: Australas J Ageing
Pays: Australia
ID NLM: 9808874
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
revised:
16
02
2023
received:
11
05
2022
accepted:
26
03
2023
medline:
21
9
2023
pubmed:
15
5
2023
entrez:
15
5
2023
Statut:
ppublish
Résumé
Advance care planning (ACP) is an important part of routine medical care. However, Western Australia (WA) consistently demonstrates poor rates of completion. International and interstate ACP programs have previously led to an increase in ACP discussion and documentation. This study aimed at evaluating the effect of a multifaceted intervention on completion of ACP in a geriatric outpatient setting in WA. The Plan-Do-Study-Act (PDSA) cycle was used for this audit. The components of the intervention comprised of education and communication skill training, improving access to ACP documents and patient resources. Pre- and post-intervention reviews of documented future care planning discussions were performed and compared. Of the 100 patients audited, there was an absolute increase of 23% (p = 0.02) in any form of future care planning. More specifically, discussions regarding ACP increased by 13% (p = 0.01), Advance Care Directive (ACD) by 23% (p < 0.001), Enduring Power of Attorney (EPA) by 24% (p = 0.02), Enduring Power of Guardianship (EPG) by 31% (p = 0.002), together with a 10% (p = 0.02) increase in the provision of ACP resources to patients. Older patient age (p = 0.02) and abnormal cognitive testing (p = 0.02), but not established dementia, were patient-related factors associated with initiation of ACP discussions. A simple structured multifaceted intervention improved the uptake of ACP discussions in a hospital geriatric clinic.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
577-583Subventions
Organisme : The Australian and New Zealand Society of Geriatric Medicine Western Australia
Informations de copyright
© 2023 AJA Inc’.
Références
Sudore RL, Lum HD, You JJ, et al. Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. J Pain Symptom Manage. 2017;53(5):821-832.
Batchelor F, Hwang K, Haralambous B, et al. Facilitators and barriers to advance care planning implementation in Australian aged care settings: a systematic review and thematic analysis. Australas J Ageing. 2019;38(3):173-181.
Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005;330(7498):1007-1011.
Australian Health Ministers' Advisory Council. National strategic framework for chronic conditions. Canberra. 2017. Accessed October 2, 2019. https://www1.health.gov.au/internet/main/publishing.nsf/Content/A0F1B6D61796CF3DCA257E4D001AD4C4/$File/National%20Strategic%20Framework%20for%20Chronic%20Conditions.pdf
Scott I, Rajakaruna N, Shah D, Miller L, Reymond E, Daly M. Normalising advance care planning in a general medicine service of a tertiary hospital: an exploratory study. Aust Health Rev. 2015;40:391-398.
Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010;340:c1345.
White B, Tilse C, Wilson J, et al. Prevalance and predictors of advance directives in Australia. Intern Med J. 2014;44:975-980.
Detering KM, Buck K, Ruseckaite R, et al. Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study. BMJ Open. 2019;9(1):e025255.
Jimenez G, Tan WS, Virk AK, Low CK, Car J, Ho AHY. Overview of systematic reviews of advance care planning: summary of evidence and global lessons. J Pain Symptom Manage. 2018;56(3):436-459.
Scott IA, Mitchell GK, Reymond J, Daly MP. Difficult but necessary conversations - the case for advance care planning. Med J Aust. 2013;199(10):662-666.
Fernandes G. Implementation of best practice in advance care planning in an ‘ageing in place’ aged care facility. Int J Evid Based Healthc. 2008;6:270-276.
Flo E, Husebo BS, Bruusgaard P, et al. A review of the implementation and research strategies of advance care planning in nursing homes. BMC Geriatr. 2016;16(1):24.
Song K, Amatya B, Khan F. Advance care planning in rehabilitation: an implementation study. J Rehabil Med. 2018;50(7):652-660.
Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE. Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf. 2014;23(4):290-298.
Reed JE, Card AJ. The problem with plan-do-study-act cycles. BMJ Qual Saf. 2016;25(3):147-152.
Trzepacz PT, Hochstetler H, Wang S, Walker B, Saykin AJ, Alzheimer's Disease Neuroimaging Initiative. Relationship between the Montreal cognitive assessment and mini-mental state examination for assessment of mild cognitive impairment in older adults. BMC Geriatr. 2015;15(1):107.
Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699.
The Oxford Medical Education Team. Abbreviated Mental Test Score (AMTS). The Oxford Medical Education Team; 2020. Accessed January 20, 2021. http://www.oxfordmedicaleducation.com/geriatrics/amts/
Weathers E, O'Caoimh R, Cornally N, et al. Advance care planning: a systematic review of randomised controlled trials conducted with older adults. Maturitas. 2016;91:101-109.
Sable-Smith A, Arnett KR, Nowels MA, Colborn K, Lum HD, Nowels D. Interactions with the healthcare system influence advance care planning activities: results from a representative survey in 11 developed countries. Fam Pract. 2018;35(3):307-311.
de Caprariis PJ, Rucker B, Lyon C. Discussing advance care planning and directives in the general population. South Med J. 2017;110(9):563-568.
Sharp T, Moran E, Kuhn I, Barclay S. Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis. Br J Gen Pract. 2013;63(615):e657-e668.
Rhee J, Meller A, Krysinska K, et al. Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: a study protocol for a randomised controlled trial. BMJ Open. 2019;9(1):e023107.
Berns SH, Camargo M, Meier DE, Yuen JK. Goals of care ambulatory resident education: training residents in advance care planning conversations in the outpatient setting. J Palliat Med. 2017;20(12):1345-1351.
Ditto P, Jacobson J, Smucker W, Danks J, Fagerlin A. Context changes choices: a prospective study of the effects of hospitalization on life-sustaining treatment preferences. Med Decis Making. 2006;26(4):313-322.
Caplan GA, Meller A, Squires B, Chan S, Willett W. Advance care planning and hospital in the nursing home. Age Ageing. 2006;35(6):581-585.
Buck K, Detering KM, Pollard A, et al. Concordance between self-reported completion of advance care planning documentation and availability of documentation in Australian health and residential aged care services. J Pain Symptom Manage. 2019;58(2):264-274.
Advance care planning documents in My Health Record [Internet]. Western Australian Health Department Health Support Services. 2020. Accessed September 26, 2020. https://wahealthdept.sharepoint.com/sites/hss-customer-ict-core-clinical/My%20Health%20Record/Forms/AllItems.aspx?id=%2Fsites%2Fhss%2Dcustomer%2Dict%2Dcore%2Dclinical%2FMy%20Health%20Record%2FAdvance%20Care%20Planning%20documents%20in%20My%20Health%20Record%20May%202020%2Epdf&parent=%2Fsites%2Fhss%2Dcustomer%2Dict%2Dcore%2Dclinical%2FMy%20Health%20Record
Barkley A, Liquori M, Cunningham A, Liantonio J, Worster B, Parks S. Advance care planning in a geriatric primary care clinic: a retrospective chart review. Am J Hosp Palliat Med. 2019;36(1):24-27.