Violet Vines Marshman Centre of Rural Health Research, La Trobe University, Bendigo, Victoria, Australia
Social Work, Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia.
BMJ Open Qual. 2024 Nov 2;13(4):e002727. doi: 10.1136/bmjoq-2023-002727.
An advance care plan outlines a patient's wishes regarding medical treatment or goals of care in the case that they become unable to communicate or to make decisions. An advance care directive (ACD) is an advance care plan that has been formally recorded and has legal status. Despite ACDs playing an important role in person-centred end-of-life care, an earlier retrospective medical records audit demonstrated that only 11% (58/531) of people who died due to a terminal illness had an ACD.The aim of this project was to increase the proportion of patients with a terminal illness completing an ACD. A secondary outcome was to measure the impact of ACDs on hospital and intensive care unit (ICU) admissions in the last 6 months of life.This multifaceted project comprised (1) education for health professionals and the public; (2) individual support for patients on request; (3) development of online resources for health professionals and the general public; and (4) monthly team meetings.
The proportion of ACDs completed and hospital and ICU admissions during the last 6 months of life, were extracted via medical record audits.Written consent was required for patients to participate, including being contacted by the project team and accessing their medical records.
112 patients consented to participate in the project and 109 (97%) completed an ACD. There was no reduction in the average number of hospital admissions, while ICU admissions reduced from 14% (n=74) to 0%.
The targeted, multifaceted approach to education and support for completion of ACDs, resulted in a significant increase in ACD completion and a major reduction in ICU admissions.
预先医疗指示（ACP）概述了患者在无法沟通或做出决策的情况下关于医疗治疗或护理目标的意愿。预先医疗指示是已正式记录并具有法律地位的预先医疗计划。尽管 ACP 在以患者为中心的临终关怀中发挥着重要作用，但早期回顾性病历审计表明，只有 11%（58/531）因绝症去世的人有 ACP。该项目的目的是增加完成 ACP 的绝症患者的比例。次要结果是衡量 ACP 对生命最后 6 个月内医院和重症监护病房（ICU）入院的影响。这个多方面的项目包括（1）对卫生专业人员和公众的教育；（2）根据患者要求提供的个人支持；（3）为卫生专业人员和公众开发在线资源；（4）每月团队会议。
通过病历审计提取完成 ACP 的比例和生命最后 6 个月内的医院和 ICU 入院情况。患者需要书面同意参与，包括接受项目团队的联系和访问他们的病历。
112 名患者同意参与该项目，其中 109 名（97%）完成了 ACP。平均住院人数没有减少，而 ICU 入院人数从 14%（n=74）减少到 0%。
针对完成 ACP 的教育和支持的有针对性的、多方面的方法，导致 ACP 完成率显著提高，ICU 入院率大幅降低。
