Osman Abdi D, Howell Jocelyn, Yeoh Michael, Lam Louisa, Jones Daryl, Braitberg George
Department of Critical Care. Parkville, University of Melbourne, Melbourne, VIC, Australia.
Emergency Department. Heidelberg, Austin Health, Melbourne, VIC, Australia.
BMC Palliat Care. 2024 Oct 1;23(1):235. doi: 10.1186/s12904-024-01566-5.
Advance Care Planning (ACP) refers to a process that includes Advance Care Directives (ACD) and Goals of Care (GOC), a practice widely used for over three decades. Following the findings of an audit and a cross-sectional study in 2019 and 2021 respectively, we implemented several educational and other interventional strategies aimed at enhancing staff awareness and emphasizing the importance of recognizing and documenting of ACD/GOC. The aim of this study was to evaluate the acknowledgement and use of ACD and GOC by Emergency Department (ED) staff following these interventions.
We used a mixed methods approach, incorporating both observational and cross-sectional designs with reflexive thematic analysis. Data extraction for the observational study took place between 1st April and 30th June 2023 focusing on a target population of randomly sampled adults aged ≥ 65 years. Demographics and other ACD and GOC related patients' clinical data were collected. Data collection for the cross-sectional study occurred between 19th July and 13th September 2023 targeting all ED staff. Information gathered included demographics, awareness about ACD and GOC, including storage location and implementation, as well as knowledge of Medical Treatment decision Makers (MTDM), a jurisdictional term identifying a person legally appointed to make healthcare decisions on behalf of someone who lacks decision-making capacity and other Victorian State legislative requirements were collected.
In the observational period, 22,335 patients attended the ED and 19% (n = 6546) qualified for inclusion from which a sample of 308 patients were randomly extracted. We found ACD documents were noted in the medical records of 6.5% of the sample, fewer than 8% identified in our previous study. There was no correlation between ACD record availability and age (p = 0.054; CI ranging from - 0.065 to 7.768). The response rate for the cross-sectional survey was 12% (n = 340) in contrast to earlier study with 28% (n = 476) respondents. Staff knowledge and familiarity with ACD was 25% and GOC 45%.
After implementing interventions in staff education and ACP awareness, we found that ACD documentation did not improve. However, GOC documentation increased in the context of heightened institutional awareness and integration into the Electronic Medical Records (EMR).
预先护理计划（ACP）是一个包括预先护理指示（ACD）和护理目标（GOC）的过程，这一做法已广泛应用三十多年。分别根据2019年的一项审计结果和2021年的一项横断面研究结果，我们实施了多项教育及其他干预策略，旨在提高工作人员的认识，并强调识别和记录ACD/GOC的重要性。本研究的目的是评估在这些干预措施实施后急诊科（ED）工作人员对ACD和GOC的认知及使用情况。
我们采用了混合方法，将观察性设计和横断面设计与反思性主题分析相结合。观察性研究的数据提取于2023年4月1日至6月30日进行，重点针对年龄≥65岁的随机抽样成年目标人群。收集了人口统计学信息以及其他与ACD和GOC相关的患者临床数据。横断面研究的数据收集于2023年7月19日至9月13日进行，目标是所有急诊科工作人员。收集的信息包括人口统计学信息、对ACD和GOC的认识，包括存储位置和实施情况，以及对医疗治疗决策者（MTDM）的了解，MTDM是一个管辖术语，指被合法指定代表缺乏决策能力的人做出医疗保健决策的人，还收集了其他维多利亚州的立法要求。
在观察期内，22335名患者到急诊科就诊，其中19%（n = 6546）符合纳入标准，从中随机抽取了308名患者作为样本。我们发现，样本中有6.5%的患者病历中记录了ACD文件，低于我们之前研究中发现的8%。ACD记录的可用性与年龄之间没有相关性（p = 0.054；置信区间为-0.065至7.768）。横断面调查的回复率为12%（n = 340），而早期研究中的回复率为28%（n = 476）。工作人员对ACD的了解程度为25%，对GOC的了解程度为45%。
在实施了工作人员教育和ACP意识方面的干预措施后，我们发现ACD文件记录并没有得到改善。然而，在机构意识提高并整合到电子病历（EMR）的背景下，GOC文件记录有所增加。
