Advance Care Planning for Patients with advanced illnesses attending hospital outpatient clinics study

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Advance Care Planning (ACP) is a process of reflection, discussion and communication that enables a person to plan for their future medical treatment and other care, for a time when they are not competent to make, or communicate, decisions for themselves. ACP could significantly improve the quality of care provided to patients with advanced illnesses. ACP allows patients to have a voice, to receive patient-centred care, in the setting of their choice, and avoid unwanted hospitalisations and inappropriate treatments. The importance of ACP in patient care has been widely recognised. The Australian Government National Health and Hospitals Reform Commission (2009) recommended the implementation of a national program of ACP in Australia. ACP has been widely endorsed by a large number of professional groups, specialist colleges, peak bodies and patient advocate groups. The NSW Health’s policy on ACP is outlined in the 2013 document ‘Advance Planning for Quality Care at End of Life: Action Plan 2013-18’. Among others, it shows that NSW Health’s priority is to: (i) incorporate ACP into routine care; (ii) educate health professionals in both conducting and responding to ACP; and (iii) improve collaboration between NSW clinical services and community and primary care health professionals. The policy also noted deficiencies that currently exist in NSW Health clinical services in identifying and recognising patients who might be at risk of dying in the near future. The intervention is informed by the Diffusion of Innovation Theory. This theory states that for innovation to be taken up, five conditions need to be met - relative advantage, compatibility, complexity (how difficult the innovation appears), trialability and observability (whether positive outcomes of the innovation can be observed). This means that didactic education sessions alone are unlikely to be sufficient to lead to significant increase in ACP undertaken by health professionals. This intervention will allow clinical services to ‘see’ a few, ‘do’ a few, and ‘teach’ a few, thereby embedding ACP firmly into routine care of patients. GPs of participating patients will be exposed to ACP documents and information material; the chance of them engaging with the educational material is significantly increased because they relate to their own patients. This research aims to trial and evaluate on patients attending NSW hospital clinics with advanced illnesses identified as potentially having supportive and palliative care needs, a model of ACP that seeks to: (i) increase the uptake of ACP by patients; and (ii) encourage NSW Health clinical services and GPs and other health professionals providing care for the patients to incorporate ACP into routine care. This study seeks to determine if this model of ACP will reduce acute health resources utilisation; improve the quality of care for patients and caregivers/family; and result in improved understanding and uptake of ACP by health professionals.