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Inadequate completion of advance care directives by individuals with dementia: national audit of health and aged care facilities.
BMJ Support Palliat Care. 2021 Jan 04 [Online ahead of print]BS

Abstract

OBJECTIVES

(i) Describe the prevalence and type of advance care directives (ACDs) and other advance care planning (ACP) documentation completed by persons with dementia, healthcare providers and others on behalf of a person with dementia; (ii) identify the personal and ACP programme characteristics associated with having ACP documentation in the health record; (iii) identify the personal and ACP programme characteristics associated with having a self-completed ACD.

METHODS

A multicentre audit was undertaken in Australian hospitals, general practices and residential aged care facilities. Auditors extracted demographic and ACP data from the records of eligible patients. ACP programme characteristics were provided by a site representative. Logistic and multinomial regression were used respectively to examine the factors associated with completion of any ACP documentation, and self-completion of an ACD by persons with dementia.

RESULTS

A total of 1388 people with dementia (33.2%) from 96 sites were included. Overall, 60.8% (n=844) had ACP documentation; 31.6% (n=438) had a self-completed ACD and 29.3% (n=406) had an ACP document completed by a health professional or someone else on their behalf. Older participants were more likely to have ACP documented. Multivariate analyses indicated the odds of having self-completed ACP documents, compared with no advance care plan or ACP completed by someone else, were significantly influenced by age, country of birth, setting and whether the site had ACP training, policies or guidelines.

DISCUSSION

While 60% of people with dementia had some form of ACP documentation, only half of the cases in which ACP was documented included an ACD completed by the person themselves.

Authors+Show Affiliations

Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia jamie.bryant@newcastle.edu.au. Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia. Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia. Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia.School of Psychology, University of New South Wales, Sydney, New South Wales, Australia. Australian Research Council Centre of Excellence in Population Ageing Research, University of New South Wales, Sydney, New South Wales, Australia. Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia. Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia. Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia. Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33397661

Citation

Bryant, Jamie, et al. "Inadequate Completion of Advance Care Directives By Individuals With Dementia: National Audit of Health and Aged Care Facilities." BMJ Supportive & Palliative Care, 2021.
Bryant J, Sellars M, Sinclair C, et al. Inadequate completion of advance care directives by individuals with dementia: national audit of health and aged care facilities. BMJ Support Palliat Care. 2021.
Bryant, J., Sellars, M., Sinclair, C., Detering, K., Buck, K., Waller, A., White, B., & Nolte, L. (2021). Inadequate completion of advance care directives by individuals with dementia: national audit of health and aged care facilities. BMJ Supportive & Palliative Care. https://doi.org/10.1136/bmjspcare-2020-002767
Bryant J, et al. Inadequate Completion of Advance Care Directives By Individuals With Dementia: National Audit of Health and Aged Care Facilities. BMJ Support Palliat Care. 2021 Jan 4; PubMed PMID: 33397661.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inadequate completion of advance care directives by individuals with dementia: national audit of health and aged care facilities. AU - Bryant,Jamie, AU - Sellars,Marcus, AU - Sinclair,Craig, AU - Detering,Karen, AU - Buck,Kimberly, AU - Waller,Amy, AU - White,Ben, AU - Nolte,Linda, Y1 - 2021/01/04/ PY - 2020/11/01/received PY - 2020/12/06/revised PY - 2020/12/09/accepted PY - 2021/1/5/entrez PY - 2021/1/6/pubmed PY - 2021/1/6/medline KW - clinical decisions KW - end of life care KW - terminal care JF - BMJ supportive & palliative care JO - BMJ Support Palliat Care N2 - OBJECTIVES: (i) Describe the prevalence and type of advance care directives (ACDs) and other advance care planning (ACP) documentation completed by persons with dementia, healthcare providers and others on behalf of a person with dementia; (ii) identify the personal and ACP programme characteristics associated with having ACP documentation in the health record; (iii) identify the personal and ACP programme characteristics associated with having a self-completed ACD. METHODS: A multicentre audit was undertaken in Australian hospitals, general practices and residential aged care facilities. Auditors extracted demographic and ACP data from the records of eligible patients. ACP programme characteristics were provided by a site representative. Logistic and multinomial regression were used respectively to examine the factors associated with completion of any ACP documentation, and self-completion of an ACD by persons with dementia. RESULTS: A total of 1388 people with dementia (33.2%) from 96 sites were included. Overall, 60.8% (n=844) had ACP documentation; 31.6% (n=438) had a self-completed ACD and 29.3% (n=406) had an ACP document completed by a health professional or someone else on their behalf. Older participants were more likely to have ACP documented. Multivariate analyses indicated the odds of having self-completed ACP documents, compared with no advance care plan or ACP completed by someone else, were significantly influenced by age, country of birth, setting and whether the site had ACP training, policies or guidelines. DISCUSSION: While 60% of people with dementia had some form of ACP documentation, only half of the cases in which ACP was documented included an ACD completed by the person themselves. SN - 2045-4368 UR - https://www.unboundmedicine.com/medline/citation/33397661/Inadequate_completion_of_advance_care_directives_by_individuals_with_dementia:_national_audit_of_health_and_aged_care_facilities_ L2 - https://spcare.bmj.com/lookup/pmidlookup?view=long&pmid=33397661 DB - PRIME DP - Unbound Medicine ER -
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