title: Development and evaluation of an aged care specific Advance Care Plan.
abstract: OBJECTIVE
  To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention.
  
  
  METHODS
  An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot of an aged care specific Advance Care Plan template; an audit of the completeness and quality of Advance Care Plans completed on the new template during a systematic ACP intervention.
  
  
  METHODS
  19 selected RACFs (managed by 12 aged care organisations) in metropolitan and regional areas of Victoria.
  
  
  RESULTS
  Documentation in use at facilities prior to the ACP intervention most commonly recorded preferences regarding hospital transfer, life prolonging treatment and personal/cultural/religious wishes. However, 7 of 12 document sets failed to adequately and clearly specify the resident's preferences as regards life prolonging medical treatment. The newly developed aged care specific Advance Care Plan template was met with approval by participating RACFs. Of 203 Advance Care Plans completed on the template throughout the project period, 49% included the appointment of a Medical Enduring Power of Attorney. Requests concerning medical treatment were specified in almost all completed documents (97%), with 73% nominating the option of refusal of life-prolonging treatment. Over 90% of plans included information concerning residents' values and beliefs, and future health situations that the resident would find to be unacceptable were specified in 78% of completed plans.
  
  
  CONCLUSIONS
  Standardised procedures and documentation are needed to improve the quality of processes, documents and outcomes of ACP in the residential aged care sector.
authors.affiliation: Respecting Patient Choices, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Silvester
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Parslow
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Lewis
authors.forename: Rachael S
authors.initials: RS
authors.lastname: Fullam
authors.forename: Rebekah
authors.initials: R
authors.lastname: Sjanta
authors.forename: Lynne
authors.initials: L
authors.lastname: Jackson
authors.forename: Vanessa
authors.initials: V
authors.lastname: White
authors.forename: Rosalie
authors.initials: R
authors.lastname: Hudson
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration* / Q000592:standards*; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D004282:Documentation / Q000379:methods* / Q000592:standards; D006707:Homes for the Aged / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008020:Life Support Care / Q000458:organization & administration / Q000592:standards; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D010347:Patient Care Planning / Q000458:organization & administration / Q000592:standards; D057240:Patient Preference / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration; D013727:Terminal Care / Q000458:organization & administration / Q000592:standards; D014739:Victoria
keywords: Advance Care Planning; Advance Directives; Aged Care; End-of-life; Nursing Homes; Terminal Care