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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 08; 58(2):264-274.JP

Abstract

CONTEXT

Advance care planning (ACP) documentation needs to be available at the point of care to guide and inform medical treatment decision-making.

OBJECTIVE

To examine concordance between self-reported completion of ACP documentation and self-reported storage of the documentation at the person's current point of care with the availability of the documentation in that person's health record.

METHODS

A national multicenter audit of health records and a self-report survey of eligible audit participants in 51 Australian health and residential aged care services. The audit assessed availability of ACP documentation in the health record, whereas the survey assessed self-reported completion and storage of the ACP documentation at the person's current place of care. To ascertain concordance, survey and audit data were cross-tabulated and concordance rates and kappa statistics were calculated overall and by health care sector and ACP documentation type.

RESULTS

The audit included 2285 people, of whom 1082 were eligible for the survey. Of 507 who completed the survey (response rate = 47%), 272 (54%) reported completing ACP documentation, of whom 130 (48%) had documentation identified in the audit. Conversely, 39 of 235 people (17%) who reported not completing ACP documentation had documentation identified (concordance rate = 64%; κ = 0.303, P < .001). The concordance rate increased to 79% when self-reported storage of ACP documentation at the person's current point of care was compared with the existence of the document in their health record (κ = 0.510, P < .001). Concordance varied by health care setting and type of ACP documentation.

CONCLUSION

Discrepancies exist between self-reported completion of ACP documentation and the presence of these documents in the health records of older adults, representing a significant patient safety issue. Public education campaigns and improvements to systems for document storage and accessibility are required to support person-centered medical and end-of-life care.

Authors+Show Affiliations

Advance Care Planning Australia, Austin Health, Melbourne, Australia. Electronic address: kim.buck@austin.org.au.Advance Care Planning Australia, Austin Health, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia.Advance Care Planning Australia, Austin Health, Melbourne, Australia.Advance Care Planning Australia, Austin Health, Melbourne, Australia.Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.Advance Care Planning Australia, Austin Health, Melbourne, Australia.Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Australia.Centre of Excellence in Population Ageing Research, University of New South Wales, Sydney, Australia.Advance Care Planning Australia, Austin Health, Melbourne, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31029805

Citation

Buck, Kimberly, et al. "Concordance Between Self-Reported Completion of Advance Care Planning Documentation and Availability of Documentation in Australian Health and Residential Aged Care Services." Journal of Pain and Symptom Management, vol. 58, no. 2, 2019, pp. 264-274.
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.
Buck, K., Detering, K. M., Pollard, A., Sellars, M., Ruseckaite, R., Kelly, H., White, B. P., Sinclair, C., & Nolte, L. (2019). Concordance Between Self-Reported Completion of Advance Care Planning Documentation and Availability of Documentation in Australian Health and Residential Aged Care Services. Journal of Pain and Symptom Management, 58(2), 264-274. https://doi.org/10.1016/j.jpainsymman.2019.04.026
Buck K, 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. PubMed PMID: 31029805.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concordance Between Self-Reported Completion of Advance Care Planning Documentation and Availability of Documentation in Australian Health and Residential Aged Care Services. AU - Buck,Kimberly, AU - Detering,Karen M, AU - Pollard,Annabel, AU - Sellars,Marcus, AU - Ruseckaite,Rasa, AU - Kelly,Helana, AU - White,Benjamin P, AU - Sinclair,Craig, AU - Nolte,Linda, Y1 - 2019/04/25/ PY - 2019/03/13/received PY - 2019/04/18/revised PY - 2019/04/18/accepted PY - 2019/4/29/pubmed PY - 2020/9/17/medline PY - 2019/4/29/entrez KW - Advance care directive KW - advance care planning KW - audit KW - concordance KW - documentation accessibility KW - quality SP - 264 EP - 274 JF - Journal of pain and symptom management JO - J Pain Symptom Manage VL - 58 IS - 2 N2 - CONTEXT: Advance care planning (ACP) documentation needs to be available at the point of care to guide and inform medical treatment decision-making. OBJECTIVE: To examine concordance between self-reported completion of ACP documentation and self-reported storage of the documentation at the person's current point of care with the availability of the documentation in that person's health record. METHODS: A national multicenter audit of health records and a self-report survey of eligible audit participants in 51 Australian health and residential aged care services. The audit assessed availability of ACP documentation in the health record, whereas the survey assessed self-reported completion and storage of the ACP documentation at the person's current place of care. To ascertain concordance, survey and audit data were cross-tabulated and concordance rates and kappa statistics were calculated overall and by health care sector and ACP documentation type. RESULTS: The audit included 2285 people, of whom 1082 were eligible for the survey. Of 507 who completed the survey (response rate = 47%), 272 (54%) reported completing ACP documentation, of whom 130 (48%) had documentation identified in the audit. Conversely, 39 of 235 people (17%) who reported not completing ACP documentation had documentation identified (concordance rate = 64%; κ = 0.303, P < .001). The concordance rate increased to 79% when self-reported storage of ACP documentation at the person's current point of care was compared with the existence of the document in their health record (κ = 0.510, P < .001). Concordance varied by health care setting and type of ACP documentation. CONCLUSION: Discrepancies exist between self-reported completion of ACP documentation and the presence of these documents in the health records of older adults, representing a significant patient safety issue. Public education campaigns and improvements to systems for document storage and accessibility are required to support person-centered medical and end-of-life care. SN - 1873-6513 UR - https://www.unboundmedicine.com/medline/citation/31029805/Concordance_Between_Self_Reported_Completion_of_Advance_Care_Planning_Documentation_and_Availability_of_Documentation_in_Australian_Health_and_Residential_Aged_Care_Services_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0885-3924(19)30231-3 DB - PRIME DP - Unbound Medicine ER -