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Decision-making for older patients by Australian and New Zealand doctors with Advance Care Directives: a vignette-based study.
Intern Med J. 2019 09; 49(9):1146-1153.IM

Abstract

BACKGROUND

Little is known about doctors' decision-making patterns when using Advance Care Directives (ACDs), particularly for older patients in Australia and New Zealand.

AIMS

To determine the level of agreement among Australian and New Zealand doctors' decisions when using ACDs to guide treatment decisions for older patients. To evaluate factors that may affect decision-making including doctors' demographics, vignette complexity and Advance Care Directive (ACD) content.

METHODS

In December 2016-January 2017, a survey was distributed to doctors working within one tertiary hospital network in Melbourne and to doctors registered with the Australian and New Zealand Society of Geriatric Medicine. The survey comprised of three vignettes (1, 2, 3) presented with deidentified versions of genuine ACDs (A and B) volunteered by community members via a tertiary hospital ACD service.

RESULTS

Five hundred and sixty doctors submitted completed surveys. The level of agreement between doctors when using ACDs varied by vignette complexity, ACD content, doctor speciality (P = 0.006 vignette 1 ACD A, P = 0.04 vignette 1 ACD B, P = 0.04 vignette 2 ACD A, P = 0.04 vignette 3 ACD B) and doctor seniority (P = 0.04 vignette 1 ACD A, P < 0.0001 vignette 2 ACD A). Australian and New Zealand doctors are infrequently exposed to ACDs in their work, 30% did not know the legal status of ACDs and majority of the cohort requested more education on ACDs.

CONCLUSION

Despite the presence of an ACD, the level of agreement on treatment decisions for older patients when using ACDs varies by vignette complexity, ACD content, speciality and seniority of doctors.

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Authors+Show Affiliations

Mitropoulos J
Department of Aged Care Services, Alfred Health, Melbourne, Victoria, Australia.
Austin N
Department of Aged Care Services, Alfred Health, Melbourne, Victoria, Australia.
Hunter P
Department of Aged Care Services, Alfred Health, Melbourne, Victoria, Australia.
Cairney H
Advance Care Planning Department, Alfred Health, Melbourne, Victoria, Australia.
Parikh S
Department of Aged Care Services, Alfred Health, Melbourne, Victoria, Australia.

MeSH

Advance DirectivesAustraliaClinical Decision-MakingFemaleHealth Knowledge, Attitudes, PracticeHumansMaleNew ZealandPalliative CarePhysiciansSurveys and Questionnaires

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30779287

Citation

Mitropoulos, Joanna, et al. "Decision-making for Older Patients By Australian and New Zealand Doctors With Advance Care Directives: a Vignette-based Study." Internal Medicine Journal, vol. 49, no. 9, 2019, pp. 1146-1153.
Mitropoulos J, Austin N, Hunter P, et al. Decision-making for older patients by Australian and New Zealand doctors with Advance Care Directives: a vignette-based study. Intern Med J. 2019;49(9):1146-1153.
Mitropoulos, J., Austin, N., Hunter, P., Cairney, H., & Parikh, S. (2019). Decision-making for older patients by Australian and New Zealand doctors with Advance Care Directives: a vignette-based study. Internal Medicine Journal, 49(9), 1146-1153. https://doi.org/10.1111/imj.14263
Mitropoulos J, et al. Decision-making for Older Patients By Australian and New Zealand Doctors With Advance Care Directives: a Vignette-based Study. Intern Med J. 2019;49(9):1146-1153. PubMed PMID: 30779287.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decision-making for older patients by Australian and New Zealand doctors with Advance Care Directives: a vignette-based study. AU - Mitropoulos,Joanna, AU - Austin,Nicole, AU - Hunter,Peter, AU - Cairney,Helena, AU - Parikh,Seema, PY - 2018/06/13/received PY - 2018/12/21/revised PY - 2019/02/02/accepted PY - 2019/2/20/pubmed PY - 2020/4/16/medline PY - 2019/2/20/entrez KW - Australia KW - advance directive KW - advance directive adherence KW - aged KW - decision-making SP - 1146 EP - 1153 JF - Internal medicine journal JO - Intern Med J VL - 49 IS - 9 N2 - BACKGROUND: Little is known about doctors' decision-making patterns when using Advance Care Directives (ACDs), particularly for older patients in Australia and New Zealand. AIMS: To determine the level of agreement among Australian and New Zealand doctors' decisions when using ACDs to guide treatment decisions for older patients. To evaluate factors that may affect decision-making including doctors' demographics, vignette complexity and Advance Care Directive (ACD) content. METHODS: In December 2016-January 2017, a survey was distributed to doctors working within one tertiary hospital network in Melbourne and to doctors registered with the Australian and New Zealand Society of Geriatric Medicine. The survey comprised of three vignettes (1, 2, 3) presented with deidentified versions of genuine ACDs (A and B) volunteered by community members via a tertiary hospital ACD service. RESULTS: Five hundred and sixty doctors submitted completed surveys. The level of agreement between doctors when using ACDs varied by vignette complexity, ACD content, doctor speciality (P = 0.006 vignette 1 ACD A, P = 0.04 vignette 1 ACD B, P = 0.04 vignette 2 ACD A, P = 0.04 vignette 3 ACD B) and doctor seniority (P = 0.04 vignette 1 ACD A, P < 0.0001 vignette 2 ACD A). Australian and New Zealand doctors are infrequently exposed to ACDs in their work, 30% did not know the legal status of ACDs and majority of the cohort requested more education on ACDs. CONCLUSION: Despite the presence of an ACD, the level of agreement on treatment decisions for older patients when using ACDs varies by vignette complexity, ACD content, speciality and seniority of doctors. SN - 1445-5994 UR - https://www.unboundmedicine.com/medline/citation/30779287/Decision_making_for_older_patients_by_Australian_and_New_Zealand_doctors_with_Advance_Care_Directives:_a_vignette_based_study_ L2 - https://doi.org/10.1111/imj.14263 DB - PRIME DP - Unbound Medicine ER -