Current practices, barriers and enablers for advance care planning among healthcare workers of aged care facilities in western New South Wales, Australia

Introduction: Advance Care Planning (ACP) and Advance Care Directives (ACDs) play a vital role in preparing for end-of-life care. However, current literature suggests that uptake of ACP and ACDs in rural Australia is low, which may contribute to lower quality care for the older rural population as patients’ end-of-life wishes may not be recognised and acknowledged. This study aims to provide a current perspective on the attitudes and practices of healthcare workers from Residential Aged Care Facilities (RACFs) towards ACP and ACDs in the Central West, Far West and Orana regions of NSW.

Methods: A mixed-methods study incorporating anonymous survey and individual interviews. Healthcare workers from 12 RACFs within the studied region completed surveys (n=109). The 40-item survey assessed participant demographics, training and experience with ACP and ACD, attitudes towards ACP and ACDs, and barriers and facilitators towards the use of ACP and ACDs in their organisation. Five participants were interviewed to explore these issues in more depth.

Results: Almost three-quarters (71%) of respondents thought that ACP is necessary while almost half (48%) were involved with >5 ACDs in the past 12 months. Formal training was seen as beneficial by most (81%) but the importance of practical experience was also acknowledged. No statistically significant differences were found in attitudes between those with <5 years and those with >5 years of experience. Avoidance of unnecessary resuscitation was a consistent theme in all interviews and the potential of a nurse-led model of delivery was identified. Patient factors like decreased capacity to make informed decisions were identified as barriers which could be circumvented by pre-emptive implementation of ACP discussion. The rural setting was identified as a facilitator due to a supportive community, which helped to mitigate barriers like limited staffing.

Conclusions: Attitudes towards ACP in rural NSW are highly positive. The rural setting is a facilitator to ACP and ACDs are approached in a multidisciplinary fashion. Further training is an identified need although on-the-ground experience may be more beneficial.