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Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients.
BMJ Support Palliat Care. 2017 Dec; 7(4):486-494.BS

Abstract

OBJECTIVES

Conduct a prospective comparative effectiveness cohort study comparing two models of advance care planning (ACP) provision in community aged care: ACP conducted by the client's case manager (CM) ('Facilitator') and ACP conducted by an external ACP service ('Referral') over a 6-month period.

METHODS

This Australian study involved CMs and their clients. Eligible CM were English speaking, ≥18 years, had expected availability for the trial and worked ≥3 days per week. CMs were recruited via their organisations, sequentially allocated to a group and received education based on the group allocation. They were expected to initiate ACP with all clients and to facilitate ACP or refer for ACP. Outcomes were quantity of new ACP conversations and quantity and quality of new advance care directives (ACDs).

RESULTS

30 CMs (16 Facilitator, 14 Referral) completed the study; all 784 client's files (427 Facilitator, 357 Referral) were audited. ACP was initiated with 508 (65%) clients (293 Facilitator, 215 Referral; p<0.05); 89 (18%) of these (53 Facilitator, 36 Referral) and 41 (46%) (13 Facilitator, 28 Referral; p<0.005) completed ACDs. Most ACDs (71%) were of poor quality/not valid. A further 167 clients (facilitator 124; referral 43; p<0.005) reported ACP was in progress at study completion.

CONCLUSIONS

While there were some differences, overall, models achieved similar outcomes. ACP was initiated with 65% of clients. However, fewer clients completed ACP, there was low numbers of ACDs and document quality was generally poor. The findings raise questions for future implementation and research into community ACP provision.

Authors+Show Affiliations

Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia. Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, Victoria, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia. Kolling Institute, Northern Clinical School, The University of Sydney, Camperdown, New South Wales, Australia.Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Victoria, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28918387

Citation

Detering, Karen Margaret, et al. "Prospective Comparative Effectiveness Cohort Study Comparing Two Models of Advance Care Planning Provision for Australian Community Aged Care Clients." BMJ Supportive & Palliative Care, vol. 7, no. 4, 2017, pp. 486-494.
Detering KM, Carter RZ, Sellars MW, et al. Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients. BMJ Support Palliat Care. 2017;7(4):486-494.
Detering, K. M., Carter, R. Z., Sellars, M. W., Lewis, V., & Sutton, E. A. (2017). Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients. BMJ Supportive & Palliative Care, 7(4), 486-494. https://doi.org/10.1136/bmjspcare-2017-001372
Detering KM, et al. Prospective Comparative Effectiveness Cohort Study Comparing Two Models of Advance Care Planning Provision for Australian Community Aged Care Clients. BMJ Support Palliat Care. 2017;7(4):486-494. PubMed PMID: 28918387.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients. AU - Detering,Karen Margaret, AU - Carter,Rachel Zoe, AU - Sellars,Marcus William, AU - Lewis,Virginia, AU - Sutton,Elizabeth Anne, Y1 - 2017/09/16/ PY - 2017/05/01/received PY - 2017/07/20/revised PY - 2017/08/30/accepted PY - 2017/9/18/pubmed PY - 2018/9/19/medline PY - 2017/9/18/entrez KW - advance care directive KW - advance care planning KW - community aged care KW - home care packages SP - 486 EP - 494 JF - BMJ supportive & palliative care JO - BMJ Support Palliat Care VL - 7 IS - 4 N2 - OBJECTIVES: Conduct a prospective comparative effectiveness cohort study comparing two models of advance care planning (ACP) provision in community aged care: ACP conducted by the client's case manager (CM) ('Facilitator') and ACP conducted by an external ACP service ('Referral') over a 6-month period. METHODS: This Australian study involved CMs and their clients. Eligible CM were English speaking, ≥18 years, had expected availability for the trial and worked ≥3 days per week. CMs were recruited via their organisations, sequentially allocated to a group and received education based on the group allocation. They were expected to initiate ACP with all clients and to facilitate ACP or refer for ACP. Outcomes were quantity of new ACP conversations and quantity and quality of new advance care directives (ACDs). RESULTS: 30 CMs (16 Facilitator, 14 Referral) completed the study; all 784 client's files (427 Facilitator, 357 Referral) were audited. ACP was initiated with 508 (65%) clients (293 Facilitator, 215 Referral; p<0.05); 89 (18%) of these (53 Facilitator, 36 Referral) and 41 (46%) (13 Facilitator, 28 Referral; p<0.005) completed ACDs. Most ACDs (71%) were of poor quality/not valid. A further 167 clients (facilitator 124; referral 43; p<0.005) reported ACP was in progress at study completion. CONCLUSIONS: While there were some differences, overall, models achieved similar outcomes. ACP was initiated with 65% of clients. However, fewer clients completed ACP, there was low numbers of ACDs and document quality was generally poor. The findings raise questions for future implementation and research into community ACP provision. SN - 2045-4368 UR - https://www.unboundmedicine.com/medline/citation/28918387/Prospective_comparative_effectiveness_cohort_study_comparing_two_models_of_advance_care_planning_provision_for_Australian_community_aged_care_clients_ L2 - http://spcare.bmj.com/cgi/pmidlookup?view=long&amp;pmid=28918387 DB - PRIME DP - Unbound Medicine ER -