Silvester William, Parslow Ruth A, Lewis Virginia J, Fullam Rachael S, Sjanta Rebekah, Jackson Lynne, White Vanessa, Hudson Rosalie
Respecting Patient Choices, Austin Health, Heidelberg, Victoria, Australia.
BMJ Support Palliat Care. 2013 Jun;3(2):188-95. doi: 10.1136/bmjspcare-2012-000392. Epub 2013 Mar 15.
To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention.
An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot of an aged care specific Advance Care Plan template; an audit of the completeness and quality of Advance Care Plans completed on the new template during a systematic ACP intervention.
19 selected RACFs (managed by 12 aged care organisations) in metropolitan and regional areas of Victoria.
Documentation in use at facilities prior to the ACP intervention most commonly recorded preferences regarding hospital transfer, life prolonging treatment and personal/cultural/religious wishes. However, 7 of 12 document sets failed to adequately and clearly specify the resident's preferences as regards life prolonging medical treatment. The newly developed aged care specific Advance Care Plan template was met with approval by participating RACFs. Of 203 Advance Care Plans completed on the template throughout the project period, 49% included the appointment of a Medical Enduring Power of Attorney. Requests concerning medical treatment were specified in almost all completed documents (97%), with 73% nominating the option of refusal of life-prolonging treatment. Over 90% of plans included information concerning residents' values and beliefs, and future health situations that the resident would find to be unacceptable were specified in 78% of completed plans.
Standardised procedures and documentation are needed to improve the quality of processes, documents and outcomes of ACP in the residential aged care sector.
报告在澳大利亚维多利亚州部分地区进行系统干预之前，老年护理机构（RACF）中使用的预先护理计划（ACP）文件的质量；报告干预期间使用的特定老年护理预先护理计划模板的开发和实施情况。
对参与的老年护理机构中用于记录居民治疗偏好和临终愿望的现有文件质量进行审核；开发并试用特定老年护理预先护理计划模板；对系统ACP干预期间在新模板上完成的预先护理计划的完整性和质量进行审核。
维多利亚州大都市和地区的19家选定的老年护理机构（由12家老年护理组织管理）。
在ACP干预之前，机构中使用的文件最常记录有关转院、延长生命治疗以及个人/文化/宗教愿望的偏好。然而，12套文件中有7套未能充分且明确地规定居民在延长生命医疗方面的偏好。参与的老年护理机构认可新开发的特定老年护理预先护理计划模板。在整个项目期间，在该模板上完成的203份预先护理计划中，49%包括指定医疗持久授权书。几乎所有已完成的文件（97%）都明确了有关治疗的请求，其中73%指定了拒绝延长生命治疗的选项。超过90%的计划包含了有关居民价值观和信仰的信息，78%已完成的计划中明确了居民认为不可接受的未来健康状况。
需要标准化的程序和文件，以提高老年护理领域ACP流程、文件和结果的质量。
