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Prospective comparative effectiveness cohort study comparing two models of advance care planning provision for Australian community aged care clients
  1. Karen Margaret Detering1,2,
  2. Rachel Zoe Carter1,
  3. Marcus William Sellars1,3,
  4. Virginia Lewis4 and
  5. Elizabeth Anne Sutton1
  1. 1 Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
  2. 2 Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, Victoria, Australia
  3. 3 Kolling Institute, Northern Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
  4. 4 Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Karen Margaret Detering, Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia; karen.detering{at}


Objectives Conduct a prospective comparative effectiveness cohort study comparing two models of advance care planning (ACP) provision in community aged care: ACP conducted by the client’s case manager (CM) (‘Facilitator’) and ACP conducted by an external ACP service (‘Referral’) over a 6-month period.

Methods This Australian study involved CMs and their clients. Eligible CM were English speaking, ≥18 years, had expected availability for the trial and worked ≥3 days per week. CMs were recruited via their organisations, sequentially allocated to a group and received education based on the group allocation. They were expected to initiate ACP with all clients and to facilitate ACP or refer for ACP. Outcomes were quantity of new ACP conversations and quantity and quality of new advance care directives (ACDs).

Results 30 CMs (16 Facilitator, 14 Referral) completed the study; all 784 client’s files (427 Facilitator, 357 Referral) were audited. ACP was initiated with 508 (65%) clients (293 Facilitator, 215 Referral; p<0.05); 89 (18%) of these (53 Facilitator, 36 Referral) and 41 (46%) (13 Facilitator, 28 Referral; p<0.005) completed ACDs. Most ACDs (71%) were of poor quality/not valid. A further 167 clients (facilitator 124; referral 43; p<0.005) reported ACP was in progress at study completion.

Conclusions While there were some differences, overall, models achieved similar outcomes. ACP was initiated with 65% of clients. However, fewer clients completed ACP, there was low numbers of ACDs and document quality was generally poor. The findings raise questions for future implementation and research into community ACP provision.

  • advance care planning
  • advance care directive
  • home care packages
  • community aged care

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  • Handling editor Declan Walsh

  • Contributors KMD, RZC and EAS: conception, design, interpretation and drafting of manuscript; MWS and VL: conception, design, interpretation and review of manuscript; and MWS and RZC: participant training and support and data collection. KMD is the guarantor.

  • Funding This work was supported by programme funding received from the Australian Government Department of Health.

  • Competing interests None declared.

  • Ethics approval Austin Health’s institutional research ethics committee (Ref LNR/14/Austin/309).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.