Increasing the uptake of advance care directives through staff education and one-on-one support for people facing end-of-life

Autor: Tony Lower, Megan Hobbs, Leigh David Kinsman, Graeme Mooney, Gail Whiteford, Bev Morris, Kerry Bartlett, Alycia Jacob, Dan Curley
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: BMJ Open Quality, Vol 13, Iss 4 (2024)
Druh dokumentu: article
ISSN: 2399-6641
DOI: 10.1136/bmjoq-2023-002727
Popis: Background 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.Method 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.Results 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%.Conclusion 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.
Databáze: Directory of Open Access Journals