Introduction
Advance care planning (ACP) conversations may result in preferences for future medical decisions being documented in an advance care directive (ACD), the identification of the person’s medical treatment decision maker (MTDM), and storage of this information in the health record, for when a person can no longer make their own decisions. The goal of ACP is that people receive preference aligned care.
Aim
To understand current practices relating to ACP and the prevalence of ACD documents in the health records in Victorian cancer services.
Method
The study involved a mixed methods design. The study examined a statewide, retrospective, cohort of Victorians who died from cancer between 1 July 2018 and 30 June 2019, for patterns of end-of-life care. Data sources included the Victorian Cancer Registry, the Victorian Death Index, Victorian Admitted Episode Dataset, the Victorian Emergency Minimum Dataset, and the Victorian Integrated Non-Admitted Health dataset. The study also examined ACP systems, policy, and resources across 73 Victorian health services via survey.
Results
Of the 10,145 people who died from cancer, 55% were male, 39% lived outside a metropolitan area. 67% of patients died in an acute or palliative care bed in a hospital. Only 12% had documented evidence of an ACD and 10% evidence of their MTDM. Of the 73 health services, 38% had a dedicated ACP workforce. 27% (n=20) of ACP policies did not include health professional obligations and 34% (n=25) did not include guidance on enactment of preferences.
Conclusion
This study identified variation in ACP practice from optimal care. There is a lack of planning for future medical treatment decisions and a low prevalence of ACDs in the health records of people facing end-of-life care for cancer. The Victorian Integrated Cancer Services have been tasked to implement recommendations and action service improvement activities.