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Prevalence of advance care planning practices among people with chronic diseases in hospital and community settings: a retrospective medical record audit.
BMC Health Serv Res. 2021 Apr 05; 21(1):303.BH

Abstract

BACKGROUND

Advance Care Planning (ACP) enables healthcare professionals to embrace the important process where patients think about their values in life and goals for health care, and discuss their future health care preferences with family members for a time when they are not able to make health care decisions. Despite the promotion of ACP last two decades, and well-known benefits of ACP and a written Advance Care Directive (ACD), they are still underutilised in Australia and across the world. Previous studies have provided some insights, however, an uptake of ACP and prevalence of ACDs in community settings is rarely reported.

METHODS

The aim of this study was to determine the uptake of ACP and prevalence of ACDs among people with chronic diseases in hospital and community settings. A retrospective medical record audit of eligible patients looking for evidence of ACP was conducted in 16 research sites in eight hospital and eight community care settings. Participants included those who were admitted to one of the research sites, and who were aged 18 years and over with at least one of nine nominated chronic diseases. The primary outcome measures included the number of patients with evidence of ACP through the following practices: completion of an ACD, appointment of an Enduring Guardian (EG), or completion of a resuscitation plan.

RESULTS

The overall prevalence of ACD was 2.8% (n = 28) out of 1006 audited records, and only 10 (1%) of them were legally binding. The number of EGs appointed was 39 (3.9%) across the sites. A total of 151 (15.4%) resuscitation plans were found across the eight hospital sites. 95% (n = 144) of the resuscitation plans indicated 'Not-for-resuscitation'.

CONCLUSIONS

The uptake of ACP is very low. Current medical recording system reveals the challenges in ACP lie in the process of storage, access and execution of the ACDs. Given that having an ACD or Enduring Guardian in place is only useful if the treating physician knows how and where to access the information, it has implications for policy, information system, and healthcare professionals' education.

TRIAL REGISTRATION

The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx.

Authors+Show Affiliations

School of Nursing and Midwifery, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW, 2258, Australia. Sarah.Jeong@newcastle.edu.au.Department of Aged Care Services, Wyong Hospital, Central Coast Local Health District, PO Box 4200, Lakehaven, NSW, 2263, Australia.Hunter New England Nursing and Midwifery Research Centre, Hunter New England Local Health District, James Fletcher Campus, Gate Cottage, 72 Watt St, Newcastle, NSW, 2300, Australia.Division of Aged, Subacute and Complex Care, Central Coast Local Health District, PO Box 6088, Long Jetty, NSW, 2261, Australia.School of Nursing and Midwifery, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW, 2258, Australia.School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33820535

Citation

Jeong, Sarah, et al. "Prevalence of Advance Care Planning Practices Among People With Chronic Diseases in Hospital and Community Settings: a Retrospective Medical Record Audit." BMC Health Services Research, vol. 21, no. 1, 2021, p. 303.
Jeong S, Barrett T, Ohr SO, et al. Prevalence of advance care planning practices among people with chronic diseases in hospital and community settings: a retrospective medical record audit. BMC Health Serv Res. 2021;21(1):303.
Jeong, S., Barrett, T., Ohr, S. O., Cleasby, P., Davey, R., & David, M. (2021). Prevalence of advance care planning practices among people with chronic diseases in hospital and community settings: a retrospective medical record audit. BMC Health Services Research, 21(1), 303. https://doi.org/10.1186/s12913-021-06265-y
Jeong S, et al. Prevalence of Advance Care Planning Practices Among People With Chronic Diseases in Hospital and Community Settings: a Retrospective Medical Record Audit. BMC Health Serv Res. 2021 Apr 5;21(1):303. PubMed PMID: 33820535.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of advance care planning practices among people with chronic diseases in hospital and community settings: a retrospective medical record audit. AU - Jeong,Sarah, AU - Barrett,Tomiko, AU - Ohr,Se Ok, AU - Cleasby,Peter, AU - Davey,Ryan, AU - David,Michael, Y1 - 2021/04/05/ PY - 2020/10/09/received PY - 2021/03/10/accepted PY - 2021/4/6/entrez PY - 2021/4/7/pubmed PY - 2021/4/7/medline KW - Advance care directive KW - Advance care planning KW - Chronic disease KW - Clinical trial KW - Community KW - Hospital SP - 303 EP - 303 JF - BMC health services research JO - BMC Health Serv Res VL - 21 IS - 1 N2 - BACKGROUND: Advance Care Planning (ACP) enables healthcare professionals to embrace the important process where patients think about their values in life and goals for health care, and discuss their future health care preferences with family members for a time when they are not able to make health care decisions. Despite the promotion of ACP last two decades, and well-known benefits of ACP and a written Advance Care Directive (ACD), they are still underutilised in Australia and across the world. Previous studies have provided some insights, however, an uptake of ACP and prevalence of ACDs in community settings is rarely reported. METHODS: The aim of this study was to determine the uptake of ACP and prevalence of ACDs among people with chronic diseases in hospital and community settings. A retrospective medical record audit of eligible patients looking for evidence of ACP was conducted in 16 research sites in eight hospital and eight community care settings. Participants included those who were admitted to one of the research sites, and who were aged 18 years and over with at least one of nine nominated chronic diseases. The primary outcome measures included the number of patients with evidence of ACP through the following practices: completion of an ACD, appointment of an Enduring Guardian (EG), or completion of a resuscitation plan. RESULTS: The overall prevalence of ACD was 2.8% (n = 28) out of 1006 audited records, and only 10 (1%) of them were legally binding. The number of EGs appointed was 39 (3.9%) across the sites. A total of 151 (15.4%) resuscitation plans were found across the eight hospital sites. 95% (n = 144) of the resuscitation plans indicated 'Not-for-resuscitation'. CONCLUSIONS: The uptake of ACP is very low. Current medical recording system reveals the challenges in ACP lie in the process of storage, access and execution of the ACDs. Given that having an ACD or Enduring Guardian in place is only useful if the treating physician knows how and where to access the information, it has implications for policy, information system, and healthcare professionals' education. TRIAL REGISTRATION: The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx. SN - 1472-6963 UR - https://www.unboundmedicine.com/medline/citation/33820535/Prevalence_of_advance_care_planning_practices_among_people_with_chronic_diseases_in_hospital_and_community_settings:_a_retrospective_medical_record_audit_ L2 - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06265-y DB - PRIME DP - Unbound Medicine ER -
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