Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.
Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia.
BMJ Open. 2019 Jan 15;9(1):e025255. doi: 10.1136/bmjopen-2018-025255.
It is important that the outcomes of advance care planning (ACP) conversations are documented and available at the point of care. Advance care directives (ACDs) are a subset of ACP documentation and refer to structured documents that are completed and signed by competent adults. Other ACP documentation includes informal documentation by the person or on behalf of the person by someone else (eg, clinician, family). The primary objectives were to describe the prevalence and correlates of ACDs among Australians aged 65 and over accessing health and residential aged care services. The secondary aim was to describe the prevalence of other ACP documentation.
A prospective multicentre health record audit in general practices (n=13), hospitals (n=12) and residential aged care facilities (RACFs; n=26).
503 people attending general practice, 574 people admitted to hospitals and 1208 people in RACFs.
Prevalence of one or more ACDs; prevalence of other ACP documentation.
29.8% of people had at least one ACD on file. The majority were non-statutory documents (20.9%). ACD prevalence was significantly higher in RACFs (47.7%) than hospitals (15.7%) and general practices (3.2%) (p<0.001), and varied across jurisdictions. Multivariate logistic regression showed that the odds of having an ACD were positively associated with greater functional impairment and being in an RACF or hospital compared with general practice. 21.6% of people had other ACP documentation.
In this study, 30% of people had ACDs accessible and a further 20% had other ACP documentation, suggesting that approximately half of participants had some form of ACP. Correlates of ACD completion were greater impairment and being in an RACF or hospital. Greater efforts to promote and standardise ACDs across jurisdictions may help to assist older people to navigate and complete ACDs and to receive care consistent with their preferences.
ACTRN12617000743369.
在医疗护理点记录并提供预先医疗护理计划（ACP）对话的结果非常重要。预先医疗指示（ACD）是 ACP 文件记录的一个子集，指的是由具有完全行为能力的成年人完成并签署的结构化文件。其他 ACP 文件记录包括由个人或他人（例如临床医生、家属）代表个人进行的非结构化记录。主要目标是描述在接受医疗和养老院服务的 65 岁及以上澳大利亚人中，ACD 的流行程度和相关因素。次要目标是描述其他 ACP 文件记录的流行程度。
在普通诊所（n=13）、医院（n=12）和养老院（RACF；n=26）进行前瞻性多中心健康记录审核。
参加普通诊所的 503 人，住院的 574 人，入住养老院的 1208 人。
至少有一份 ACD 存档的人数比例；其他 ACP 文件记录的流行程度。
29.8%的人有一份或多份 ACD 存档。大多数是无法律效力的文件（20.9%）。RACF 中的 ACD 患病率（47.7%）明显高于医院（15.7%）和普通诊所（3.2%）（p<0.001），且各司法管辖区之间存在差异。多变量逻辑回归显示，与普通诊所相比，功能障碍程度更大、在 RACF 或医院中，拥有 ACD 的可能性更高。21.6%的人有其他 ACP 文件记录。
在这项研究中，30%的人可以访问 ACD，还有 20%的人有其他 ACP 文件记录，这表明大约一半的参与者有某种形式的 ACP。完成 ACD 的相关因素是功能障碍程度更大和在 RACF 或医院中。在各司法管辖区内加大力度促进和规范 ACD 可能有助于帮助老年人了解并完成 ACD，并获得符合其偏好的护理。
ACTRN12617000743369。
