Background:
Advance care planning (ACP) supports people to consider and communicate their future treatment preferences and document them in an advance care directive (ACD). ACP and the use of ACDs is supported by Australian health legislation and is a key priority in the National Palliative Care Strategy and Cancer Optimal Care Pathways. However, no data has been available to monitor ACD prevalence in an Australian cancer population. This study aimed to describe the prevalence of ACDs among people with cancer aged 65+ years accessing general practice (GP), hospitals and residential aged care facilities.
Methods:
Prospective cross-jurisdictional study consisting of health record audit. The primary outcomes was presence of an ACD. Secondary outcomes included quality of ACDs and prevalence of medical orders.
Results:
4187 records were audited in 100 organisations (15 GPs, 27 hospitals, 58 RACFs) representing all eight Australian jurisdictions. Of these, 628 had the medical condition cancer and the prevalence of ACDs was 29.5% compared to 25.3% in the overall population. 8.0% were statutory ACDs preferences for care, 16.1% ACDs appointing a substitute decision-maker, 11.5% were non-statutory ACDs, and 42.4% medical orders. Non-statutory ACDs were more likely to not contain date of birth, be signed, dated or witnessed.
Conclusion(s):
This study is the first to examine ACP documentation prevalence in an Australian cancer population and at the point of care. The prevalence of ACDs for older persons with cancer was low at approximately 30%. Recommendations to improve ACP uptake include: community awareness and information, workforce education, care pathways inclusive of ACP and accessibility should be supported by national systems such as My Health Record.