Article Text

PDF

Oral Abstracts - ACP Concepts/Evaluation
The effectiveness of employing exclusive advance care planning (ACP) clinicians
  1. K Wallis1,
  2. K Detering1,
  3. K Whiteside1,
  4. D Mawren1 and
  5. W Silvester1
  1. 1Respecting Patient Choices Program Austin Health

Abstract

ACP improves end-of-life care and patient/family satisfaction. Nevertheless, health professionals struggle to include ACP in their busy work schedule in a university hospital environment. In response, since 2008, the Respecting Patient Choices Program has employed nurses exclusively to do ACP. A prospective audit of the activity of these “ACP Clinicians” was conducted 1/1/2010 – 31/12/2011. The audit included patient demographics, reason for referral and ACP activity and outcomes. 1866 patients (median age 76 (18-110), 51% male) were referred. Their primary admission diagnoses were cancer 23% or renal-18%, respiratory-12% or cardiac-10% failure. The main reasons for referral were age/debility/multiple co-morbidities or poor prognosis. Prior to referral 11.5 % of patients had previously appointed a substitute decision maker (SDM), and 5% had completed an advance care plan. 1703/1866 (91%) referred patients were seen by an ACP Clinician. Of these 45% of patients completed ACP documentation: SDM alone (33%), advance care plan alone (11%) or a combination of both (56%). If documents were completed, the time spent per patient was longer (median 90 mins vs. 45 mins) and the number of visits were more (median 2 vs. 1). When patients completed an advance care plan outlining treatment preferences, 56% expressed a wish to not receive cardiopulmonary resuscitation, 45% did not want life-prolonging treatment at all, 45% only wanted treatment if a patient-defined reasonable outcome was expected, and a further 7% delegated the decision to others. Employment of ACP clinicians is an effective method of providing ACP, enabling patients to complete documents if desired.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.