Efficacy of Normalisation of Advance Care Planning (NACP) for people with chronic diseases in hospital and community settings: a quasi-experimental study

BMC Health Services Research

Tomiko Barrett¹  Peter Cleasby²  Christopher Oldmeadow³  Ryan Davey⁴  Sarah Jeong⁴  Se Ok Ohr⁵ 

[1] Department of Aged Care Services, Wyong Hospital, PO Box 4200, Central Coast Local Health District, 2263, Lakehaven, NSW, Australia;Division of Aged, Subacute and Complex Care, PO Box 6088, Central Coast Local Health District, 2261, Long Jetty, NSW, Australia;Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights, 2305, Newcastle, NSW, Australia;School of Nursing and Midwifery, University of Newcastle, 10 Chittaway Road, 2258, Ourimbah, NSW, Australia;School of Nursing and Midwifery, University of Newcastle, 10 Chittaway Road, 2258, Ourimbah, NSW, Australia;Hunter New England Nursing and Midwifery Research Centre, Hunter New England Local Health District, James Fletcher Campus, Gate Cottage, 72 Watt St, 2300, Newcastle, NSW, Australia;

关键词: Advance care planning;    Advance care directives;    Hospital;    Community;    Nurses;   

DOI  :  10.1186/s12913-021-06928-w

来源: Springer

【 摘 要 】

BackgroundAdvance Care Planning (ACP) has emerged to improve end-of-life processes and experiences. However, the available evidence presents the gloomy picture of increasing number of older people living with chronic diseases and the mismatch between their preferences for and the actual place of death. The study aimed to investigate the efficacy of normalisation of an Advance Care Planning (NACP) service delivered by specially trained Registered Nurses (RNs) in hospital and community settings.MethodsA quasi-experimental study was conducted involving 16 sites (eight hospital and eight community sites) in Australia. Patients who were aged ≥18 years, who had at least one of nine chronic conditions, and who did not have an Advance Care Directive (ACD) were offered the NACP service. ACP was normalised as part of routine service on admission. The intervention, NACP, was a series of facilitated conversations about the components of ACP. The primary outcomes which included the completion of ACDs, and/or appointment of an Enduring Guardian (EG), were assessed in both intervention and control sites at pre and post intervention stages. Numbers of patients who completed an ACD or appointed an EG were described by count (percentage). ACD completion was compared between intervention and control sites using a logistic mixed effects regression model. The model includes fixed effects for treatment group, period, and their interaction, as well as random site level intercepts. Secondary model included potentially confounding variables as covariates, including age, sex and chronic diseases.ResultsThe prevalence of legally binding ACDs in intervention sites has increased from five to 85 (from 0.85% in pre to 17.6% in post), whereas it has slightly decreased from five to 2 (from 1.2% in pre and to 0.49% in post) in control sites (the difference in these changes being statistically significant p < 0.001). ACD completion rate was 3.6% (n = 4) in LHD1 and 1.2% (n = 3) in LHD2 in hospital whereas it was 53% (n = 26) in LHD1 and 80% (n = 52) in LHD2 in community.ConclusionsThe study demonstrated that NACP service delivered by ACP RNs was effective in increasing completion of ACDs (interaction odds ratio = 50) and was more effective in community than hospital settings. Involvement of various healthcare professionals are warranted to ensure concordance of care.Trial registrationThe study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246) on 03/10/2018. The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx

【 授权许可】

CC BY