Tags

Type your tag names separated by a space and hit enter

Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators.
Health Expect. 2021 May 01 [Online ahead of print]HE

Abstract

BACKGROUND

Advance care planning (ACP) conversations may result in preferences for medical care being documented.

OBJECTIVE

To explore the uptake and quality of advance care directives (ACDs) among older Australians accessing health and aged care services, by overall ACP documentation prevalence, person-level predictors and ACD quality indicators.

DESIGN AND SETTING

National multi-centre health record audit in general practices (GP), hospitals and residential aged care facilities (RACF).

PARTICIPANTS

A total of 4187 people aged ≥65 years attending their GP (n = 676), admitted to hospital (n = 1122) or residing in a RACF (n = 2389).

MAIN OUTCOME MEASURES

ACP documentation prevalence by setting and type including person-completed ACDs and non-ACD documents (completed by a health professional or someone else); person-level predictors and quality indicators of ACDs.

RESULTS

Overall ACP documentation prevalence was 46.5% (29.2% weighted). ACD prevalence was 25.3% (14.2% weighted). Unweighted ACD prevalence was higher in RACFs (37.7%) than in hospitals (11.1%) and GPs (5.5%). 35.8% of ACP documentation was completed by a health professional (9.7% weighted), and 18.1% was completed by someone else (10.6% weighted). Having an ACD was positively associated with being female, older, having two or more medical conditions, receiving palliative care, being divorced/separated and being in a RACF. Only 73% of ACDs included full name, signature, document date and witnessing.

CONCLUSIONS AND CONTRIBUTION

Low ACP documentation prevalence and a lack of accessible, person-completed and quality ACDs represent an important ACP implementation issue. Low prevalence is complicated by poor document quality and a higher prevalence of documents being completed by someone other than the person.

Authors+Show Affiliations

Advance Care Planning Australia, Austin Health, Heidelberg, Vic, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Vic, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Vic, Australia. Department of Health Services Research & Policy, Research School of Population Health, Australian National University, ACT, Australia.Australian Research Council Centre of Excellence in Population Ageing Research, University of New South Wales, Sydney, NSW, Australia. Neuroscience Research Australia (NeuRA), Sydney, Australia. School of Psychology, University of New South Wales, Sydney, NSW, Australia.Australian Centre for Health Research Law, Faculty of Law, Queensland University of Technology, Brisbane, Qld, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Vic, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Vic, Australia.Advance Care Planning Australia, Austin Health, Heidelberg, Vic, Australia. Faculty of Health, Arts and Innovation, Swinburne University, Hawthorn, Vic., Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33932311

Citation

Buck, Kimberly, et al. "Advance Care Directive Prevalence Among Older Australians and Associations With Person-level Predictors and Quality Indicators." Health Expectations : an International Journal of Public Participation in Health Care and Health Policy, 2021.
Buck K, Nolte L, Sellars M, et al. Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators. Health Expect. 2021.
Buck, K., Nolte, L., Sellars, M., Sinclair, C., White, B. P., Kelly, H., Macleod, A., & Detering, K. M. (2021). Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators. Health Expectations : an International Journal of Public Participation in Health Care and Health Policy. https://doi.org/10.1111/hex.13264
Buck K, et al. Advance Care Directive Prevalence Among Older Australians and Associations With Person-level Predictors and Quality Indicators. Health Expect. 2021 May 1; PubMed PMID: 33932311.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advance care directive prevalence among older Australians and associations with person-level predictors and quality indicators. AU - Buck,Kimberly, AU - Nolte,Linda, AU - Sellars,Marcus, AU - Sinclair,Craig, AU - White,Ben P, AU - Kelly,Helana, AU - Macleod,Ashley, AU - Detering,Karen M, Y1 - 2021/05/01/ PY - 2021/02/25/revised PY - 2020/11/25/received PY - 2021/04/02/accepted PY - 2021/5/1/entrez PY - 2021/5/2/pubmed PY - 2021/5/2/medline KW - advance care directive KW - advance care planning KW - aged care service KW - general practice KW - health service KW - prevalence JF - Health expectations : an international journal of public participation in health care and health policy JO - Health Expect N2 - BACKGROUND: Advance care planning (ACP) conversations may result in preferences for medical care being documented. OBJECTIVE: To explore the uptake and quality of advance care directives (ACDs) among older Australians accessing health and aged care services, by overall ACP documentation prevalence, person-level predictors and ACD quality indicators. DESIGN AND SETTING: National multi-centre health record audit in general practices (GP), hospitals and residential aged care facilities (RACF). PARTICIPANTS: A total of 4187 people aged ≥65 years attending their GP (n = 676), admitted to hospital (n = 1122) or residing in a RACF (n = 2389). MAIN OUTCOME MEASURES: ACP documentation prevalence by setting and type including person-completed ACDs and non-ACD documents (completed by a health professional or someone else); person-level predictors and quality indicators of ACDs. RESULTS: Overall ACP documentation prevalence was 46.5% (29.2% weighted). ACD prevalence was 25.3% (14.2% weighted). Unweighted ACD prevalence was higher in RACFs (37.7%) than in hospitals (11.1%) and GPs (5.5%). 35.8% of ACP documentation was completed by a health professional (9.7% weighted), and 18.1% was completed by someone else (10.6% weighted). Having an ACD was positively associated with being female, older, having two or more medical conditions, receiving palliative care, being divorced/separated and being in a RACF. Only 73% of ACDs included full name, signature, document date and witnessing. CONCLUSIONS AND CONTRIBUTION: Low ACP documentation prevalence and a lack of accessible, person-completed and quality ACDs represent an important ACP implementation issue. Low prevalence is complicated by poor document quality and a higher prevalence of documents being completed by someone other than the person. SN - 1369-7625 UR - https://www.unboundmedicine.com/medline/citation/33932311/Advance_care_directive_prevalence_among_older_Australians_and_associations_with_person_level_predictors_and_quality_indicators_ L2 - https://doi.org/10.1111/hex.13264 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.