Increasing the uptake of advance care directives through staff education and one-on-one support for people facing end-of-life

Journal article


Kinsman, Leigh David, Mooney, Graeme, Whiteford, Gail, Lower, Tony, Hobbs, Megan, Morris, Bev, Bartlett, Kerry, Jacob, Alycia and Curley, Dan. (2024). Increasing the uptake of advance care directives through staff education and one-on-one support for people facing end-of-life. BMJ Open Quality. 13(4), p. Article e002727. https://doi.org/10.1136/bmjoq-2023-002727
AuthorsKinsman, Leigh David, Mooney, Graeme, Whiteford, Gail, Lower, Tony, Hobbs, Megan, Morris, Bev, Bartlett, Kerry, Jacob, Alycia and Curley, Dan
Abstract

Background
An advance care plan outlines a patient’s wishes regarding medical treatment or goals of care in the case that they become unable to communicate or to make decisions. An advance care directive (ACD) is an advance care plan that has been formally recorded and has legal status. Despite ACDs playing an important role in person-centred end-of-life care, an earlier retrospective medical records audit demonstrated that only 11% (58/531) of people who died due to a terminal illness had an ACD.

The aim of this project was to increase the proportion of patients with a terminal illness completing an ACD. A secondary outcome was to measure the impact of ACDs on hospital and intensive care unit (ICU) admissions in the last 6 months of life.

This multifaceted project comprised (1) education for health professionals and the public; (2) individual support for patients on request; (3) development of online resources for health professionals and the general public; and (4) monthly team meetings.

Method
The proportion of ACDs completed and hospital and ICU admissions during the last 6 months of life, were extracted via medical record audits.

Written consent was required for patients to participate, including being contacted by the project team and accessing their medical records.

Results
112 patients consented to participate in the project and 109 (97%) completed an ACD. There was no reduction in the average number of hospital admissions, while ICU admissions reduced from 14% (n=74) to 0%.

Conclusion
The targeted, multifaceted approach to education and support for completion of ACDs, resulted in a significant increase in ACD completion and a major reduction in ICU admissions.

Year2024
JournalBMJ Open Quality
Journal citation13 (4), p. Article e002727
PublisherBMJ Publishing Group
ISSN2399-6641
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjoq-2023-002727
PubMed ID39488435
Scopus EID2-s2.0-85208290829
PubMed Central IDPMC11664345
Open accessPublished as ‘gold’ (paid) open access
Page range1-5
FunderNSW Regional Health Partners
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online02 Nov 2024
Publication process dates
Accepted15 Oct 2024
Deposited08 May 2025
Additional information

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC (https://creativecommons.org/licenses/by-nc/4.0/). No commercial re-use. See rights and permissions. Published by BMJ.

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