Improving Advance Care Planning Completion in Primary Care
Abstract
Introduction
Advance care planning (ACP) is a patient-centred discussion involving the patient, family, and healthcare professional to ensure 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 enhance quality of life, communication, and reduce 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 documentation or evidence of ACP discussions. A survey was sent to staff at Roath House Surgery to identify barriers for ACP completion.
Results
There was no ACP documentation for the sampled residents. 14.6% had no documentation or consideration of resuscitation status. 12.2% had no documented preference of where they would like to die. Limitations included inconsistencies between GP and care home record systems. The survey revealed the main barriers included lack of formal ACP training and time constraints. Intervention took place to improve ACP completion using GP concerns. This was through education, signposting to resources and making official documentation more accessible. On recollection of data after 2 months, the findings were the same. For the second cycle, residential home nursing staff were educated on ACPs, and documentation was made accessible to family members. After a further 2 months, 31% of residents had evidence of a completed ACP, or ACP in progress.
Conclusions
With an MDT approach of involving nursing staff and family members, there was a significant improvement in ACP completion. Further work is needed in exploring GP time constraints for ACP completion and a public health initiative to raise awareness of their value.
Comments
Flávia Arbex Borim
In the Brazilian context, particularly within Primary Health Care (PHC) of the Unified Health System (SUS), advance care planning (ACP) is still incipient and not yet well systematized when compared to the model described in Wales. Although PHC in Brazil, mainly organized through the Family Health Strategy, is grounded on principles such as continuity of care and strong patient–family relationships, key elements for ACP implementation, important gaps remain in practice.
Important topic
We see this often, the will to complete ACPs is there but the time to do them with appropriate people involved and documentation is often what is lacking - thoughts on tackling this? Seems to me to need a systemwide shift in attitudes...?