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It is widely acknowledged that the application of advance care planning (ACP) is an important component of personalised end-of-life care, and that recognition and accommodation of preferences expressed in ACP documents allow individuals to have control over the level of health care they receive at the end of life. 1-5 Studies conducted in different healthcare settings suggest that ACP can improve patient and family satisfaction with care, 6 7 reduce nursing home to hospital transfers, 8-10 limit the application of burdensome treatments at the end of life in line with patient preferences, 7 11 12 and reduce indicators of stress, anxiety and depression in surviving relatives. 6 7
Effective ACP requires that a number of key processes are undertaken and revised as necessary through ongoing practitioner-patient negotiations. These processes include: (i) consideration of options and expression of values; (ii) communication and documentation of preferences; (iii) identification, where possible, of a surrogate decision maker able to make decisions for treatment when these preferences and decisions cannot be made by the patient; and (iv) ensuring that such documentation is made available to practitioners across different healthcare settings, for example when the patient moves from an aged care facility to hospital. 3 13-15
Initiation of discussions leading to the completion of advance directives (ADs) is dependent on the individual policies and priorities of health managers and practitioners. 16 17 However, the impact of legislation supporting ADs is questionable even when it is enacted nationally. After the Patient Self-Determination Act was implemented in the USA in 1991, 18 higher proportions of some patient populations completed ADs, in at least some healthcare settings. 19-22 Despite this improvement in uptake, studies have indicated that there is considerable variability in the concordance between previously expressed treatment preferences and actual treatment provision. 11 23-26 Organisational policies, procedures and systems are required to reinforce and support good practice.
In Australia, legislation underwriting ADs exists in most but not all states and territories. The legislation varies in terminology, intent and associated physician liability. 27 28 A number of studies have examined aspects of ACP in Australia, including guidelines for implementing ACP in Australian healthcare settings, 1 4 29 30 the roles of different health practitioners in supporting ACP, 31-34 and the outcomes of a...