Development and Evaluation of an Aged Care Specific Advance Care Plan

Overview

Journal BMJ Support Palliat Care

Publisher BMJ Publishing Group

Specialties Critical Care
Pharmacology
Psychiatry

Date 2013 Apr 30

PMID 23626906

Citations 8

Authors

William Silvester

Ruth A Parslow

Virginia J Lewis

Rachael S Fullam

Rebekah Sjanta

Lynne Jackson

Vanessa White

Rosalie Hudson

Affiliations

Soon will be listed here.

Abstract

Objectives: To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention.

Design: An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot of an aged care specific Advance Care Plan template; an audit of the completeness and quality of Advance Care Plans completed on the new template during a systematic ACP intervention.

Participants And Setting: 19 selected RACFs (managed by 12 aged care organisations) in metropolitan and regional areas of Victoria.

Results: Documentation in use at facilities prior to the ACP intervention most commonly recorded preferences regarding hospital transfer, life prolonging treatment and personal/cultural/religious wishes. However, 7 of 12 document sets failed to adequately and clearly specify the resident's preferences as regards life prolonging medical treatment. The newly developed aged care specific Advance Care Plan template was met with approval by participating RACFs. Of 203 Advance Care Plans completed on the template throughout the project period, 49% included the appointment of a Medical Enduring Power of Attorney. Requests concerning medical treatment were specified in almost all completed documents (97%), with 73% nominating the option of refusal of life-prolonging treatment. Over 90% of plans included information concerning residents' values and beliefs, and future health situations that the resident would find to be unacceptable were specified in 78% of completed plans.

Conclusions: Standardised procedures and documentation are needed to improve the quality of processes, documents and outcomes of ACP in the residential aged care sector.

Citing Articles

Managing clinical uncertainty in older people towards the end of life: a systematic review of person-centred tools.

Ellis-Smith C, Tunnard I, Dawkins M, Gao W, Higginson I, Evans C BMC Palliat Care. 2021; 20(1):168.

PMID: 34674695 PMC: 8532380. DOI: 10.1186/s12904-021-00845-9.

Advance care planning in nursing homes: new conversation and documentation tools.

Wendrich-Van Dael A, Gilissen J, Van Humbeeck L, Deliens L, Vander Stichele R, Gastmans C BMJ Support Palliat Care. 2021; 11(3):312-317.

PMID: 34162581 PMC: 8380900. DOI: 10.1136/bmjspcare-2021-003008.

Impact of the Physician Orders for Life-Sustaining Treatment (POLST) Program Maturity Status on the Nursing Home Resident's Place of Death.

Tark A, Agarwal M, Dick A, Song J, Stone P Am J Hosp Palliat Care. 2020; 38(7):812-822.

PMID: 32878457 PMC: 7925705. DOI: 10.1177/1049909120956650.

Exploring the Uptake of Advance Care Planning in Older Adults: An Integrative Review.

Frechman E, Dietrich M, Walden R, Maxwell C J Pain Symptom Manage. 2020; 60(6):1208-1222.e59.

PMID: 32645455 PMC: 7342022. DOI: 10.1016/j.jpainsymman.2020.06.043.

Evaluation of the Interrater Reliability of End-of-Life Medical Orders in the Physician Orders for Life-Sustaining Treatment Form.

Lovadini G, Fukushima F, Schoueri J, Reis R, Fonseca C, Rodriguez J JAMA Netw Open. 2019; 2(4):e192036.

PMID: 30977852 PMC: 6481595. DOI: 10.1001/jamanetworkopen.2019.2036.

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