Advance Care Planning in the Australian Primary Care Context

Abstract

In addition to its role in improving patient autonomy, Advance Care Planning (ACP) is increasingly being recognised as an important component of quality end-of-life care. However, the literature suggests a number of problems with ACP, including the low uptake and lack of impact that Advance Care Plans currently have on future patient care. Moreover, ACP has not been incorporated into primary care in Australia despite its recognition as an ideal setting for ACP.

This thesis therefore aimed to explore: the current state of ACP and how it is conceptualised in Australia; the perspectives of Australian general practitioners (GPs) on how end-of-life care decisions are made; and Australian GPs’ perspectives on the influence that various contextual factors have on the facilitation and implementation of ACP.

The study was guided by Qualitative Description and Grounded Theory methodologies. Study data was collected from interviews with the representatives of key stakeholder organisations, policymakers, expert clinicians and GPs.

The findings showed that ACP is conceptualised as having both autonomy-centric and non-autonomy-centric functions and aims. The low uptake and the lack of impact of Advance Care Plans on patient care were identified as major problems affecting ACP in Australia. Recommended strategies to address this involved increasing the general awareness of ACP and implementing a system-wide program of ACP that: (i) shifts the focus away from documentation to a process of communication about patient’s wishes; (ii) improves the response of health professionals to Advance Care Plans; and (iii) improves the facilitation, documentation and accessibility of Advance Care Plans. The findings also highlighted the importance of individualising the process of ACP – particularly the role of formal documentation, and the flexibility in the implementation of the Advance Care Plan – to suit the unique needs and context of each patient. A range of contextual factors that should be taken into account when individualising ACP were identified.

In summary, this thesis provides important evidence to inform the development of an individualised, patient-centred approach to ACP that is suitable for a successful implementation in the Australian primary care setting.