Advance Care Planning Evaluation in Hospitalized Elderly Patients: A Multicenter, Prospective Study
Advance Care Planning (ACP) may offer some assistance with reducing health care costs for
older Canadians and yet, at the same time, improving quality of care. ACP is the process by
which a person considers options about future health care decisions and identifies their
wishes. ACP has been shown to increase the quality of life of dying patients, improve the
experience of family members, and decrease health care costs.
There have been initiatives leading to the development and implementation of system-wide
strategies to increase ACP, however there has been no evaluation of the effectiveness of
these efforts from the perspective of patients and families. Many questions pertaining to
barriers and facilitators to implementation and impact of ACP on outcomes in Canada remain.
The investigators propose to conduct a perspective audit of current practice related to ACP
in elderly patients at high-risk for dying and their families. The investigators will
determine the extent to which these patients and families have engaged in ACP, what barriers
and facilitators they preceive, and how satisfied they are with communication and decision
making at the end of life. Informed by a baseline evaluation of site strengths, weaknesses
and barriers, the investigators propose to develop tailored interventions to enable
participating sites to improve their success with ACP during the entire study period. By
repeating the audit and feedback cycle annually, the investigators will enable sites to make
continuous efforts to improve their performance and be able to evaluate the effect of our
audit/feedback/tailored intervention strategy compared to baseline. Additionally, for those
patients who have engaged in ACP activities, the investigators can compare their outcomes to
those who have not.
The overall goal of this study is to inform decision-makers as the best strategies to
implement advance care planning (ACP).
Time Perspective: Prospective
Extent of Implementation of ACP
Daren K Heyland, MD, MSc
Canada: Canadian Institutes of Health Research