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Prospective multicentre cross-sectional audit among older Australians accessing health and residential aged care services: protocol for a national advance care directive prevalence study.
BMJ Open. 2019 10 28; 9(10):e031691.BO

Abstract

INTRODUCTION

Advance care planning (ACP), an ongoing communication and planning process, aims to clarify a person's values and preferences, so these guide decision-making if the person becomes unable to make his or her own decisions. Ideally, ACP results in completion of advance care directives (ACD), documents completed by competent people outlining their values, treatment preferences and/or appointment of a substitute decision-maker (SDM). ACDs are most effective at the point of care, where they can be used to inform treatment decisions. Australian governments fund initiatives and have developed policy to increase ACD completion rates. However, little is known about the prevalence of ACDs at the point of care in Australian health services, making ACP evaluation efforts difficult. This study aims to determine the prevalence of ACDs in records of older people in Australian hospitals, aged care facilities and general practices.

METHODS AND ANALYSIS

This is a national multicentre cross-sectional prevalence study in selected aged care facilities, hospitals and general practices. Following a 2017 feasibility study, a new protocol incorporating key learnings was developed. Sites will be recruited via expression of interest process. Health records of people aged ≥65 years, admitted to or attending services on study day(s) will be audited by trained staff from sites. Site-level data will be collected during the expression of interest. The primary outcome is the presence of at least one ACD in the health record. Secondary outcomes include prevalence of other documented outcomes of ACP (by health practitioner(s)/family/SDM), assessment of ACD quality and content and concordance between the person's documented preferences and any medical treatment orders. Individuals and sites characteristics where ACDs are present will be explored.

ETHICS AND DISSEMINATION

Protocol approval by Austin Health Human Research Ethics Committee, Melbourne, Australia (reference: HREC/18/Austin/109). Results will be disseminated via peer-reviewed journals and conferences. Participating sites and jurisdictions will receive individualised reports of findings.

Authors+Show Affiliations

Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia karen.detering@austin.org.au. Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.Centre of Excellence in Population Aging Research, University of New South Wales, Sydney, New South Wales, Australia.Australian Centre for Health Research Law, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.

Pub Type(s)

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

Language

eng

PubMed ID

31662395

Citation

Detering, Karen M., et al. "Prospective Multicentre Cross-sectional Audit Among Older Australians Accessing Health and Residential Aged Care Services: Protocol for a National Advance Care Directive Prevalence Study." BMJ Open, vol. 9, no. 10, 2019, pp. e031691.
Detering KM, Buck K, Sellars M, et al. Prospective multicentre cross-sectional audit among older Australians accessing health and residential aged care services: protocol for a national advance care directive prevalence study. BMJ Open. 2019;9(10):e031691.
Detering, K. M., Buck, K., Sellars, M., Kelly, H., Sinclair, C., White, B., & Nolte, L. (2019). Prospective multicentre cross-sectional audit among older Australians accessing health and residential aged care services: protocol for a national advance care directive prevalence study. BMJ Open, 9(10), e031691. https://doi.org/10.1136/bmjopen-2019-031691
Detering KM, et al. Prospective Multicentre Cross-sectional Audit Among Older Australians Accessing Health and Residential Aged Care Services: Protocol for a National Advance Care Directive Prevalence Study. BMJ Open. 2019 10 28;9(10):e031691. PubMed PMID: 31662395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective multicentre cross-sectional audit among older Australians accessing health and residential aged care services: protocol for a national advance care directive prevalence study. AU - Detering,Karen M, AU - Buck,Kimberly, AU - Sellars,Marcus, AU - Kelly,Helana, AU - Sinclair,Craig, AU - White,Ben, AU - Nolte,Linda, Y1 - 2019/10/28/ PY - 2019/10/31/entrez PY - 2019/10/31/pubmed PY - 2019/10/31/medline KW - advance care directive KW - advance care planning KW - health service KW - prevalence KW - quality SP - e031691 EP - e031691 JF - BMJ open JO - BMJ Open VL - 9 IS - 10 N2 - INTRODUCTION: Advance care planning (ACP), an ongoing communication and planning process, aims to clarify a person's values and preferences, so these guide decision-making if the person becomes unable to make his or her own decisions. Ideally, ACP results in completion of advance care directives (ACD), documents completed by competent people outlining their values, treatment preferences and/or appointment of a substitute decision-maker (SDM). ACDs are most effective at the point of care, where they can be used to inform treatment decisions. Australian governments fund initiatives and have developed policy to increase ACD completion rates. However, little is known about the prevalence of ACDs at the point of care in Australian health services, making ACP evaluation efforts difficult. This study aims to determine the prevalence of ACDs in records of older people in Australian hospitals, aged care facilities and general practices. METHODS AND ANALYSIS: This is a national multicentre cross-sectional prevalence study in selected aged care facilities, hospitals and general practices. Following a 2017 feasibility study, a new protocol incorporating key learnings was developed. Sites will be recruited via expression of interest process. Health records of people aged ≥65 years, admitted to or attending services on study day(s) will be audited by trained staff from sites. Site-level data will be collected during the expression of interest. The primary outcome is the presence of at least one ACD in the health record. Secondary outcomes include prevalence of other documented outcomes of ACP (by health practitioner(s)/family/SDM), assessment of ACD quality and content and concordance between the person's documented preferences and any medical treatment orders. Individuals and sites characteristics where ACDs are present will be explored. ETHICS AND DISSEMINATION: Protocol approval by Austin Health Human Research Ethics Committee, Melbourne, Australia (reference: HREC/18/Austin/109). Results will be disseminated via peer-reviewed journals and conferences. Participating sites and jurisdictions will receive individualised reports of findings. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/31662395/Prospective_multicentre_cross_sectional_audit_among_older_Australians_accessing_health_and_residential_aged_care_services:_protocol_for_a_national_advance_care_directive_prevalence_study_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=31662395 DB - PRIME DP - Unbound Medicine ER -