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15-04-2013 | Internal medicine | Article

Advanced care planning ‘should be standard’


Free abstract

medwireNews: Quality and outcomes would likely improve If advanced care planning (ACP) processes and documentation in residential aged care facilities became standardized, say researchers in BMJ Supportive and Palliative Care.

The study findings identify key components for ACP, including noting a Medical Enduring Power of Attorney (MEPOA) in the case that a resident becomes incompetent, noting whether the resident is competent at the time of completing an ACP, and information regarding the resident's end-of-life wishes and values.

Indeed, none of the 19 aged care facilities, representing 12 distinct organizations that took part in the study covered all of these key domains, notes the team.

"Without this information, it is difficult to see how the resident's wishes could be effectively enacted," write William Silvester (Austin Hospital, Heidelberg, Victoria, Australia) and colleagues.

Differing ACP processes and documentation can impact an individual's control over their end-of-life healthcare options, and can affect quality of life, they note.

Only a third (n=4) of the organizations in the current study used documentation that clearly provided details of an individual who had been awarded MEPOA, and records of preferences at the end of life - including hospital transfer and life-prolonging treatment - were judged to be inadequate in the majority of cases.

Silvester and colleagues drafted and tested a standardized ACP template in 16 separate facilities, for 203 individuals.

In all, 49% of the standardized ACPs completed included appointment of a MEPOA, with 40% specifying that no MEPOA had been assigned. Almost all (97%) documents specified medical treatment that had been requested by individuals, with almost three-quarters (73%) nominating to refuse life-prolonging treatment.

Nearly all patients (99%) completed Silvester and colleagues' ACP listed information in the "wanted/not wanted" section of the document, with only seven individuals recording inconsistent desires. For example, one individual wanted CPR but did not want ventilation.

More than 90% of patients recorded values and/or belief statements such as their desire to maintain independence and social interactions, strong family ties, and to be treated with dignity by being kept clean and comfortable.

Of note, the vast majority (93%) of standardized ACP plans were signed by a competent resident, with 86% of these having all sections of the plan signed and witnessed correctly.

"The new document template was met with broad approval and its ease-of-use was confirmed by the high standard of completion," conclude Silvester and co-workers.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Sarah Guy, medwireNews Reporter

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