title: Is an advance care planning model feasible in community palliative care? A multi-site action research approach.
abstract: OBJECTIVE
  This article reports a study to determine the feasibility of an advance care planning model developed with Australian community palliative care services.
  
  
  BACKGROUND
  An effective advance care planning programme involves an organizational wide commitment and preparedness for health service reform to embed advance care planning into routine practice. Internationally, such programmes have been implemented predominantly in aged and acute care with more recent work in primary care.
  
  
  METHODS
  A multi-site action research was conducted over a 16-month period in 2007-2009 with three Victorian community palliative care services. Using mixed method data collection strategies to assess feasibility, we conducted a baseline audit of staff and clients; analysed relevant documents (client records, policies, procedures and quality improvement strategies) pre-implementation and post-implementation and conducted key informant interviews (n = 9).
  
  
  METHODS
  Three community palliative care services: one regional and two metropolitan services in Victoria, Australia.
  
  
  RESULTS
  The services demonstrated that it was feasible to embed the Model into their organizational structures. Advance care planning conversations and involvement of family was an important outcome measure rather than completion rate of advance care planning documents in community settings. Services adapted and applied their own concept of community, which widened the impact of the model. Changes to quality audit processes were essential to consolidate the model into routine palliative care practice.
  
  
  CONCLUSIONS
  An advance care planning model is feasible for community palliative care services. Quality audit processes are an essential component of the Model with documentation of advance care planning discussion established as an important outcome measure.
authors: School of Nursing & Midwifery La Trobe University, Bundoora Victoria, Australia. j.blackford@latrobe.edu.au
authors: Jeanine
authors: J
authors: Blackford
authors: Annette
authors: A
authors: Street
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration*; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010166:Palliative Care / Q000458:organization & administration*; D015397:Program Evaluation; D012424:Rural Population; D013727:Terminal Care / Q000458:organization & administration*; D014505:Urban Population; D014739:Victoria