Advance care planning research shows rural Victorians have double the odds of having a plan in place
New research undertaken by researchers from Monash Rural Health shows that only 2.9% of Victorian acute hospital inpatients had an advance care directive on their hospital record.
The study, published in Internal Medicine Journal, found that those living in regional Victoria had approximately double the odds of having a document compared to their metropolitan counterparts.
Advance care planning (ACP) is important for helping families facing difficult emotional situations when their loved ones are unwell, to make complex medical decisions informed by the patient, when the patient is unable to speak for themselves.
During the advance care planning process, people discuss and document their future preferences for healthcare as a reference for family and clinicians to refer to when they are very unwell, to align their care with their preferences and values.
Lead researcher Dr Laura Panozzo explained that with modern healthcare practices gravitating towards a person-centric approach, advance care planning greatly assists in shaping care that corresponds to what each person wants.
“It is important that we understand the prevalence of these documents in the acute setting, where patients are unwell and at risk of being unable to communicate decisions for themselves.”
According to the study’s findings, patients who are aged over 65 years are significantly more likely to have these documents, with the strongest associations shown for those with recurrent hospitalisation, being multi-morbid, increased age and being unpartnered. For people in rural and remote areas, having an advanced care directive was seen as being more common due to regional patients having more long standing, close and continuing relationships with their general practitioners, and generally being referred to a single hospital. Advance care planning is best done when an individual is well, and pre-existing relationships can make discussions of advanced care plans easier.
This is believed to be the largest population-level study identifying the prevalence of ACP documents among acute hospital inpatients, utilised data from over 600,000 patients from 123 different public hospitals across Victoria.
The research gives insights into the amount of advanced care plans in place and how accessible they are in hospital records. Whilst it is not generally appropriate for advance care plans to be created during an acute hospital admission, what is contained within these plans and how they are carried out in acute hospital settings would be a potential area for further study.
Dr Panozzo first began her research into advanced care planning as a medical student. She completed a Bachelor of Medical Science (Honours) exploring communication and implementation of advance care planning in regional Victoria in 2018, and after graduation, continued to combine research with her clinical load, working as a Research Fellow at Monash Rural Health in Bendigo.
Reflecting on what is important to know for an early career researcher, Dr Panozzo felt that the hardest part is getting your first experience with research but it's important to take charge of the process from start to finish yourself as the best way to learn.
“Rural health researchers are highly skilled and can be of a significant asset to people who are interested in learning more about research. My advice is to think about what areas interest you, do some brief background searching to see what is new/emerging and reach out to those around you.”
Read the full article, published in the Internal Medical Journal: Prevalence and correlates of advance care planning among Australian hospital inpatients.