Background The Australian Government funds personal and clinical support to the frail/unwell elderly to support them to live at home. These Home Care Package (HCP) clients have a case manager (CM) who, with the client and family, coordinates the client’s support services. Advance Care Planning (ACP) is important to these clients. The CMs can either assist the client with ACP (“Facilitator Model”) or refer the client to a separate ACP service (“Referral Model”).
Aim To test the Referral and Facilitator models in a Randomised Controlled Trial (RCT).
Methods CMs, who were randomised to the Referral or Facilitator models, were trained for their model and implemented to their 25 clients. The trial evaluation included:
Assessing CM knowledge, attitudes and practice regarding ACP
Auditing client’s files to measure ACP documentation quantity/quality.
Interviews/focus groups with CMs to explore perspectives/experiences/attitudes re ACP.
Result Randomisation of 35 CMs, representing 800 clients. Training improved confidence (17 CMs pre, 32 CMs post felt confident) and comfort (22 pre, 33 post felt comfortable) in discussing ACP and improved knowledge (31% pre to 80% post got 6 or 7/7 correct answers). Barriers to ACP completion include insufficient time, CM confidence and experience, client ability to access services, and engagement with GPs.
Full audit data analysis will be completed by April 2015 and presented at the ACPEL conference.
Discussion The CM knowledge of the client/family/GP/context supports the Facilitator model, whereas the expertise of the ACP service supports the Referral model. To be discussed in full at conference.
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