Introduction Enhancing advance care planning has become a policy priority in Australia and internationally. This study compares the prevalence and quality of advance care planning documents in new referrals to a community palliative care service to documents subsequently completed by the community palliative care service, as well as determining the prevalence of patients who died in their preferred place of death.

Method This retrospective chart analysis of 150 patients referred to the Gold Coast Community Palliative Care Service between January and May 2021 reviewed all types of advance care planning documents with the focus on advance health directives, the Advance Care Directive in Queensland. Accessibility, validity, and appropriateness of advance health directives was assessed. Preferred place of death was compared to actual place of death. The analysis used proportions, binomial confidence intervals and univariate logistic regression.

Results 52% of patients were male and the median age was 74 years. Most patients had a cancer diagnosis (85%). The prevalence of advance health directive completion at the time of referral was much higher than other Australian studies (27%). Referrers completed more advance health directives (27%, CI 19.8, 34.5) than community palliative care service (9%, CI 4.5, 16.1); however, had lower upload rates to the electronic medical record (42.5% vs 80%) and 29% were invalid. The strongest predictor of advance health directive completion was preparation of other advance care planning documents. Community palliative care completed more acute resuscitation plans than referrers (44% vs 25%). Completion of an acute resuscitation plan reduced advance health directive completion (p = 0.49). Home was the preferred place of death for 47% of patients. 64% of patients died at their preferred place of death.

Conclusion This study has a higher prevalence of all types of advance care planning compared to other Australian studies including advance health directives. The community palliative care service had a lower prevalence of advance health directives when compared to referrers. Accessibility remains low with less than half uploaded to the electronic medical record. Almost a third of advance health directive completed prior to referral uploaded to the electronic medical record were invalid highlighting the need to review these documents. The higher prevalence of acute resuscitation plan than advance health directive may be because of a lack of designated time, resources, and funding for opportune completion. A home death remains the goal for most patients.