School of Nursing and Midwifery, University of Newcastle, 10 Chittaway Road, Ourimbah, NSW, 2258, Australia.
Department of Aged Care Services, Wyong Hospital, Central Coast Local Health District, PO Box 4200, Lakehaven, NSW, 2263, Australia.
BMC Health Serv Res. 2021 Apr 5;21(1):303. doi: 10.1186/s12913-021-06265-y.
Advance Care Planning (ACP) enables healthcare professionals to embrace the important process where patients think about their values in life and goals for health care, and discuss their future health care preferences with family members for a time when they are not able to make health care decisions. Despite the promotion of ACP last two decades, and well-known benefits of ACP and a written Advance Care Directive (ACD), they are still underutilised in Australia and across the world. Previous studies have provided some insights, however, an uptake of ACP and prevalence of ACDs in community settings is rarely reported.
The aim of this study was to determine the uptake of ACP and prevalence of ACDs among people with chronic diseases in hospital and community settings. A retrospective medical record audit of eligible patients looking for evidence of ACP was conducted in 16 research sites in eight hospital and eight community care settings. Participants included those who were admitted to one of the research sites, and who were aged 18 years and over with at least one of nine nominated chronic diseases. The primary outcome measures included the number of patients with evidence of ACP through the following practices: completion of an ACD, appointment of an Enduring Guardian (EG), or completion of a resuscitation plan.
The overall prevalence of ACD was 2.8% (n = 28) out of 1006 audited records, and only 10 (1%) of them were legally binding. The number of EGs appointed was 39 (3.9%) across the sites. A total of 151 (15.4%) resuscitation plans were found across the eight hospital sites. 95% (n = 144) of the resuscitation plans indicated 'Not-for-resuscitation'.
The uptake of ACP is very low. Current medical recording system reveals the challenges in ACP lie in the process of storage, access and execution of the ACDs. Given that having an ACD or Enduring Guardian in place is only useful if the treating physician knows how and where to access the information, it has implications for policy, information system, and healthcare professionals' education.
The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246 ). The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx.
预先医疗指示（ACP）使医疗专业人员能够参与到重要的过程中，让患者思考其生命价值观和医疗保健目标，并与家属讨论他们未来的医疗保健偏好，以备其无法做出医疗保健决策时使用。尽管在过去二十年中一直提倡 ACP，并且 ACP 和书面预先医疗指示（ACD）具有众所周知的益处，但在澳大利亚和世界各地，ACP 的利用率仍然很低。之前的研究提供了一些见解，然而，在社区环境中，ACP 的接受程度和 ACD 的流行率很少有报道。
本研究的目的是确定在医院和社区环境中患有慢性病的人群中 ACP 的接受程度和 ACD 的流行率。在八个医院和八个社区护理机构的 16 个研究点对符合条件的患者进行了回顾性病历审核，以寻找 ACP 的证据。参与者包括在其中一个研究点住院的年龄在 18 岁及以上且至少患有九种指定慢性病之一的患者。主要结局指标包括通过以下实践证明 ACP 的患者人数：完成 ACD、指定持久监护人（EG）或完成复苏计划。
在审核的 1006 份病历中，有 28 份（2.8%）有 ACD，其中只有 10 份（1%）具有法律约束力。在各个研究点共指定了 39 名 EG（3.9%）。在八个医院研究点共发现了 151 份（15.4%）复苏计划。95%（n=144）的复苏计划表明“不复苏”。
ACP 的接受程度非常低。当前的医疗记录系统揭示了 ACP 面临的挑战在于 ACD 的存储、访问和执行过程。鉴于拥有 ACD 或持久监护人只有在治疗医生知道如何以及从何处获取信息时才有用，这对政策、信息系统和医疗保健专业人员的教育都有影响。
该研究在澳大利亚和新西兰临床试验注册中心（试验 ID：ACTRN12618001627246）进行了回顾性注册。试验注册网址为：http://www.anzctr.org.au/trial/MyTrial.aspx。
