Concordance Between Self-Reported Completion of Advance Care Planning Documentation and Availability of Documentation in Australian Health and Residential Aged Care Services

Journal of Pain and Symptom Management. 58, 2, p. 264-274 11 p.

31 Pages Posted: 27 Jun 2019 Last revised: 26 Feb 2020

See all articles by Kim Buck

Kim Buck

affiliation not provided to SSRN

Karen Detering

Austin Health

Annabel Pollard

affiliation not provided to SSRN

Marcus Sellars

affiliation not provided to SSRN

Rasa Ruseckaite

Monash University - Institute for Safety - Compensation and Recovery Research

Helana Kelly

affiliation not provided to SSRN

Ben White

Queensland University of Technology - Faculty of Law

Craig Sinclair

University of New South Wales (UNSW) - ARC Centre of Excellence in Population Ageing Research (CEPAR)

Linda Nolte

Austin Health

Date Written: 2019

Abstract

Context: Advance care planning (ACP) documentation needs to be available at the point of care to guide and inform medical treatment decision-making.

Objective: To examine concordance between self-reported completion of ACP documentation and self reported storage of the documentation at the person’s current point of care with the availability of the documentation in that person’s health record.

Methods: A national multi-centre audit of health records and a self-report survey of eligible audit participants in 51 Australian health and residential aged care services. The audit assessed availability of ACP documentation in the health record while the survey assessed self reported completion and storage of the ACP documentation at the person’s current place of care. To ascertain concordance, survey and audit data were cross-tabulated and concordance rates and kappa statistics were calculated overall, and by healthcare sector and ACP documentation type.

Results: The audit included 2285 people, of whom 1082 were eligible for the survey. Of 507 who completed the survey (response rate = 47%), 272 (54%) reported completing ACP documentation, of whom 130 (48%) had documentation identified in the audit. Conversely, 39 of 235 people (17%) who reported not completing ACP documentation had documentation identified (concordance rate = 64%; κ = 0.303, p < .001). The concordance rate increased to 79% when self-reported storage of ACP documentation at the person’s current point of care was compared with the existence of the document in their health record (κ = 0.510, p < .001). Concordance varied by health care setting and type of ACP documentation.

Conclusions: Discrepancies exist between self-reported completion of ACP documentation and the presence of these documents in the health records of older adults, representing a significant patient safety issue. Public education campaigns and improvements to systems for document storage and accessibility are required to support person-centred medical and end-of-life care.

Keywords: Advance care directive, advance care planning, audit, quality, concordance, documentation

Suggested Citation

Buck, Kim and Detering, Karen and Pollard, Annabel and Sellars, Marcus and Ruseckaite, Rasa and Kelly, Helana and White, Ben and Sinclair, Craig and Nolte, Linda, Concordance Between Self-Reported Completion of Advance Care Planning Documentation and Availability of Documentation in Australian Health and Residential Aged Care Services (2019). Journal of Pain and Symptom Management. 58, 2, p. 264-274 11 p., Available at SSRN: https://ssrn.com/abstract=3400482

Kim Buck

affiliation not provided to SSRN

Karen Detering

Austin Health ( email )

145 Studley Rd
Heidelberg VIC 3084, Melbourne
Australia

Annabel Pollard

affiliation not provided to SSRN

Marcus Sellars

affiliation not provided to SSRN

Rasa Ruseckaite

Monash University - Institute for Safety - Compensation and Recovery Research ( email )

23 Innovation Walk
Wellington Road
Clayton, Victoria 3800
Australia

Helana Kelly

affiliation not provided to SSRN

Ben White (Contact Author)

Queensland University of Technology - Faculty of Law ( email )

Level 4, C Block Gardens Point
2 George St
Brisbane, QLD 4000
Australia

HOME PAGE: http://staff.qut.edu.au/staff/whiteb/

Craig Sinclair

University of New South Wales (UNSW) - ARC Centre of Excellence in Population Ageing Research (CEPAR) ( email )

Kensington
High St
Sydney, NSW 2052
Australia

Linda Nolte

Austin Health ( email )

145 Studley Rd
Heidelberg VIC 3084, Melbourne
Australia

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