Advance Care Planning (ACP) is a process of reflection, discussion and communication that enables a person to plan for their future medical treatment and other care, for a time when they are not competent to make, or communicate, decisions for themselves. This proposal aims to extend our current study, funded by the Translational Research Grants Scheme in round one, which is a randomised controlled trial (RCT) (n=197) that aims to address the research question: can Advance Care Planning intervention provided to patients with advanced diseases attending hospital outpatient clinics identified as being at risk of dying in the next 12 months reduce unplanned hospital admissions at six months, improve patient care and encourage health professionals to incorporate ACP into routine care?
This proposal will extend the data collection to 18 months which is important because the benefits and impact of ACP are unlikely to be fully realised after just six months. We will also conduct a health economics evaluation utilising data linkage with NSW Health datasets (admitted patients collection, Ambulance data, emergency department collection), and the Medicare and PBS datasets. We will conduct an audit of patient deaths to determine if ACP results in the patient dying in the setting and receiving end-of-life care consistent with their wishes. Our proposed study will build on our current ongoing study to generate further evidence for the effectiveness of ACP for patients with advanced illnesses, including benefits from the health economics perspective and over a longer time period (of 18 months).
Positive results obtained from this study will provide the necessary evidence to policymakers and health service managers to enable them to make additional investments and therefore implement ACP at a larger scale. Our current steering group has wide representation from the local health districts, the NSW Ministry of Health, health provider organisations, primay health networks, universities, and consumer organisation. This will maximise the possibility of our findings influencing policy and clinical practice in the future.
The research questions are:
Can facilitated Advance Care Planning intervention provided to patients with advanced illnesses identified as being at risk of dying in the next 12 months attending hospital outpatient clinics:
(a) reduce unplanned hospital admissions and acute health resources utilisation after 18 months?
(b) lead to similar or lower health care costs after 18 months?
(c) result in the patient dying (if this was to occur) in the setting and in a manner consistent with their expressed wishes?
Collaborators: Sydney Local Health District, NSW Ministy of Health (Office of the Chief Health Officer), eHealth NSW, Central and Eastern Sydney Primary Health Network (Social Policy branch), NSW Ambulance Service, Alzheimer’s Australia, University of Wollongong, University of Technology Sydney