Advance care planning in rehabilitation: An implementation study
Krystal Song, Bhasker Amatya, Fary Khan
Rehabilitation, Royal Melbourne Hospital, 3052 Melbourne, Australia. E-mail: firstname.lastname@example.org
Objective: To identify implementation and process issues that influence the implementation of an advance care planning (ACP) programme in rehabilitation settings.
Methods: An ACP programme was established in an inpatient tertiary rehabilitation setting in Victoria, Australia. Rehabilitation patients with chronic illnesses were recruited and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework used. Pre-implementation measures included: patient medical record audit of ACP discussions; and barriers and facilitators analyses. Implementation interventions were staff group educational sessions and clinical process changes. Further medical record audit was carried out to review the number of ACP conversations performed and re-evaluate ACP barriers.
Results: A total of 180 consecutive inpatients were recruited for pre- (n = 90) and post- (n = 90) implementation groups. The majority of the pre-implementation cohort were female (51%), mean age 64.2 years (standard deviation 16.4 years) and had low rates of ACP discussions (n = 9, 10%). Major ACP barriers included: lack of staff education programme, and insufficient knowledge to conduct ACP. There was a significant increase in ACP conversations performed (n = 21, 23.3%) between both groups; however, staff reported limited time and skills to perform discussions.
Conclusion: This ACP programme is feasible, but needs robust process evaluation and longer term follow-up to assess the impact of outcomes in public hospital settings on care quality.
Advance care planning (ACP) is the process of planning for future healthcare and life-prolonging treatment preferences to guide clinical decision-making when one is unable to communicate decisions due to lack of capacity. We evaluated the effectiveness of an ACP programme in an inpatient rehabilitation setting in Australia with patients with chronic illnesses. This programme identified barriers and enablers, with implementation of ACP strategies in this setting, resulting in an increase in ACP conversations between rehabilitation staff and patients. The programme is feasible, but needs longer-term follow-up to assess the impact of outcomes on improved care quality.
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