Abstract
Introduction
Advance care planning (ACP) is a patient-centred discussion involving the patient, family, and healthcare professional to ensure future care aligns with patient wishes. In Wales, this includes two recognised documents for those with capacity, and a best interests form for those without, completed by a Lasting Power of Attorney or IMCA. ACPs in the elderly population have been shown to enhance quality of life, communication, and reduce unwanted hospital admissions. This project aimed to improve ACP completion in primary care.
Method
Forty-one residents, who were registered to Roath House Surgery, were sampled from Penylan House Care Home. Records from the care home and general practice (GP) were searched for recognised documentation or evidence of ACP discussions. A survey was sent to the staff working at Roath House Surgery to identify barriers for ACP completion.
Results
There was no recognised ACP documentation recorded for the sampled residents. 14.6% have no documentation or consideration of resuscitation status. 12.2% had no documented preference of where they would like to die. This was limited by inconsistencies between GP and care home records. The survey revealed that the main barriers to ACP completion was the lack of formal ACP training, time constraints and lack of awareness of the recognised ACP documents. Intervention took place to improve ACP completion using GP concerns. This was through education, signposting to training and resources and making official documentation more accessible. Despite this, on recollection of data after 2 months, the findings were the same.
Conclusions
There is some evidence of ACP discussions taking place, but the official documentation is not used which could lead to lack of clarity of patient wishes. Whilst education of ACP’s was improved amongst the GP’s, the interventions attempted were not effective in addressing the barriers to ACP completion. Further interventions are needed to address time constraints.