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Uptake of advance care planning and its circumstances: An nationwide survey in Australian general practice
Health and Social Care in the Community ( IF 2.395 ) Pub Date : 2021-09-16 , DOI: 10.1111/hsc.13570
Jinfeng Ding 1, 2 , Angus Cook 2 , Christobel Saunders 3 , David Chua 4 , Sharon Licqurish 5 , Geoffrey Mitchell 4 , Claire E. Johnson 5, 6
Affiliation  

There are potential benefits associated with advance care planning (ACP), and general practitioners (GPs) are well placed to coordinate ACP initiatives with their patients. Few studies have reported on the uptake of different forms of advance care plan conducted by GPs and how this affects patients' place of death. The primary aims of the study were to examine uptake of verbal (conversations regarding care preferences) and written (documented care preferences) advance care plans and their associated factors from the perspective of Australian GPs. The secondary aim was to determine the impact of different types of advance care plans on place of death. Sixty-one GPs from three Australian states used a validated clinic-based data collection process to report on care provided for decedents in the last year of life, including provision of services, place of death, and uptake of ACP. We found that 58 (27.9%), 91 (43.7%) and 59 (28.4%) reported decedents had no advance care plans, verbal plans or written plans, respectively. There were increased uptake of both verbal plans (relative risk ratio [RRR] = 13.10, 95% confidence interval [CI]: 2.18–77.34) and written plans (RRR = 10.61, 95% CI: 1.72–65.57) if GPs foresaw the death for >90 days versus <7 days. Palliative care training history for GPs predicted uptake of verbal plans (RRR = 5.83, 95% CI: 1.46–31.93). Patients with verbal plans versus no plans were more likely to die at a private residence (odds ratio = 4.97, 95% CI: 1.32–18.63). Our findings suggest that expectation of death for at least three months prior to the event (where clinically possible) and palliative care training for GPs improve the uptake of ACP in general practice. Larger pragmatic trials are required to determine the impact of ACP on patients’ place of death.

中文翻译:

采用预先护理计划及其情况:澳大利亚一般实践中的全国性调查

预先护理计划 (ACP) 具有潜在的好处,全科医生 (GP) 可以很好地与患者协调 ACP 计划。很少有研究报告全科医生实施不同形式的预先护理计划以及这如何影响患者的死亡地点。该研究的主要目的是从澳大利亚全科医生的角度检查口头(关于护理偏好的对话)和书面(记录在案的护理偏好)预先护理计划及其相关因素的接受情况。次要目的是确定不同类型的预先护理计划对死亡地点的影响。来自澳大利亚三个州的 61 名全科医生使用经过验证的基于诊所的数据收集流程来报告在生命最后一年为死者提供的护理,包括提供服务、死亡地点和 ACP 的摄取。我们发现分别有 58 名 (27.9%)、91 名 (43.7%) 和 59 名 (28.4%) 报告的死者没有预先护理计划、口头计划或书面计划。如果全科医生预见到,口头计划(相对风险比 [RRR] = 13.10,95% 置信区间 [CI]:2.18-77.34)和书面计划(RRR = 10.61,95% CI:1.72-65.57)的接受度都会增加死亡 > 90 天与 <7 天。全科医生的姑息治疗培训历史预测口头计划的接受度(RRR = 5.83,95% CI:1.46-31.93)。与没有计划的患者相比,有口头计划的患者更有可能在私人住宅中死亡(优势比 = 4.97,95% CI:1.32-18.63)。我们的研究结果表明,事件发生前至少三个月的死亡预期(在临床可能的情况下)和对全科医生的姑息治疗培训提高了一般实践中 ACP 的吸收。
更新日期:2021-09-16
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