title: Current advance care planning practice in the Australian community: an online survey of home care package case managers and service managers.
abstract: BACKGROUND
  Advance care planning (ACP) is the process of planning for future healthcare that is facilitated by a trained healthcare professional, whereby a person's values, beliefs and treatment preferences are made known to guide clinical decision-making at a future time when they cannot communicate their decisions. Despite the potential benefits of ACP for community aged care clients the availability of ACP is unknown, but likely to be low. In Australia many of these clients receive services through Home Care Package (HCP) programs. This study aimed to explore current attitudes, knowledge and practice of advance care planning among HCP service managers and case managers.
  
  
  METHODS
  An invitation to take part in a cross-sectional online survey was distributed by email to all HCP services across Australia in November 2012. Descriptive analyses were used to examine overall patterns of responses to each survey item in the full sample.
  
  
  RESULTS
  120 (response rate 25%) service managers and 178 (response rate 18%) case managers completed the survey. Only 34% of services had written ACP policies and procedures in place and 48% of case managers had previously completed any ACP training. In addition, although most case managers (70%) had initiated an ACP discussion in the past 12 months and viewed ACP as part of their role, the majority of the conversations (80%) did not result in documentation of the client's wishes and most (85%) of the case managers who responded did not believe ACP was done well within their service.
  
  
  CONCLUSIONS
  This survey shows low organisational ACP systems and support for case managers and a lack of a normative approach to ACP across Australian HCP services. As HCPs become more prevalent it is essential that a model of ACP is developed and evaluated in this setting, so that clients have the opportunity to discuss and document their future healthcare wishes if they choose to.
authors.affiliation: Respecting Patient Choices, Austin Health, Melbourne, Australia. marcus.sellars@austin.org.au.|Respecting Patient Choices Program, Austin Hospital, PO Box 5555, Heidelberg, Melbourne, VIC, 3084, Australia. marcus.sellars@austin.org.au.
authors.forename: Marcus
authors.initials: M
authors.lastname: Sellars
authors.affiliation: Respecting Patient Choices, Austin Health, Melbourne, Australia. karen.detering@austin.org.au.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Detering
authors.affiliation: Respecting Patient Choices, Austin Health, Melbourne, Australia. william.silvester@austin.org.au.
authors.forename: William
authors.initials: W
authors.lastname: Silvester
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D001315:Australia; D019090:Case Management / Q000458:organization & administration* / Q000592:standards; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D057766:Policy; D011795:Surveys and Questionnaires