Improving Advance Care Planning Completion in Primary Care

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.