Feasibility and acceptability of facilitated advance care planning in outpatient clinics: A qualitative study of health-care professionals experience

Kate H Marshall; Diane L Riddiford-Harland; Anne E Meller; Vanessa Kruger; Marie Kirsebom; Michael Tran; Gideon A Caplan; Vasi Naganathan; John Cullen; Peter Gonski; Nicholas Zwar; Julie-Ann O'Keeffe; Karolina Krysinska; Joel J Rhee

doi:10.1111/ajag.13272

Feasibility and acceptability of facilitated advance care planning in outpatient clinics: A qualitative study of health-care professionals experience

Australas J Ageing. 2024 Jan 23. doi: 10.1111/ajag.13272. Online ahead of print.

Authors

Kate H Marshall¹, Diane L Riddiford-Harland², Anne E Meller³, Vanessa Kruger⁴, Marie Kirsebom⁵, Michael Tran⁶, Gideon A Caplan^{7

8}, Vasi Naganathan^{9

10}, John Cullen^{9

10}, Peter Gonski¹¹, Nicholas Zwar¹², Julie-Ann O'Keeffe¹³, Karolina Krysinska¹⁴, Joel J Rhee^{1

6}

Affiliations

¹ Faculty of Medicine & Health, UNSW Academic General Practice Network, University of New South Wales, Sydney, New South Wales, Australia.
² Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.
³ Advance Care Planning Services, Prince of Wales Hospital, Sydney, New South Wales, Australia.
⁴ School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia.
⁵ Section of Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
⁶ Faculty of Medicine & Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.
⁷ Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
⁸ Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.
⁹ Faculty of Medicine and Health, Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁰ Department of Geriatric Medicine, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia.
¹¹ Southcare Aged and Extended Community Care, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.
¹² Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.
¹³ Aged, Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia.
¹⁴ Centre for Primary Health Care and Equity, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia.

PMID: 38258915
DOI: 10.1111/ajag.13272

Abstract

Objective: This study sought to determine the feasibility and acceptability of a facilitated advance care planning (ACP) intervention implemented in outpatient clinics, as perceived by health-care professionals (HCPs).

Methods: Data from seven focus groups (n = 27) and nine semi-structured interviews with HCPs recruited as part of a pragmatic, randomised controlled trial (RCT) were analysed using qualitative descriptive methodology. Components of the intervention included HCP education and training, tools to assist HCPs with patient selection, hardcopy information, and ACP documentation, and specialised nurse-facilitators to support HCPs to complete ACP conversations and documentation with patients and caregivers.

Results: Health-care professionals working in tertiary outpatient clinics perceived the facilitated ACP intervention as feasible and acceptable. Health-care professionals reported a high level of satisfaction with key elements of the intervention, including the specialised education and training, screening and assessment procedures and ongoing support from the nurse-facilitators. Health-care professionals reported this training and support increased their confidence and ACP knowledge, leading to more frequent ACP discussions with patients and their families. Health-care professionals noted their ability to conduct ACP screening and assessment in clinic was impeded by large clinical caseloads and patient-related factors (e.g., dementia diagnoses, and emotional distress). Additional barriers to ACP implementation identified by HCPs included poor collaboration, constrained time and clinical space, undefined roles and standardised recording procedures for HCPs.

Conclusions: Facilitated ACP intervention in outpatient clinics is perceived by HCPs as feasible and acceptable. Addressing barriers and tailoring implementation strategies may improve the delivery of ACP as part of tertiary outpatient care.

Keywords: advance care planning; advanced illness; health personnel; palliative care; qualitative research.

Grants and funding

Department of Health, New South Wales Government