Successful intervention to improve Advance Care Planning in a geriatrician led community service

Introduction

Advance care planning (ACP) offers patients the opportunity to plan their future care. There is an increasing role for ACP in the community, where there may be more time and chance to build rapport, than in hospital. We aimed to assess ACP engagement within our “Hospital@home” service.

Methods

Data was collected for patients referred to @home in December 2023. Those appropriate for ACP had a Clinical Frailty Score (CFS) >=6, or a comorbidity with a poor prognosis. Interventions included interactive seminars, and the creation of lanyards and posters. Senior clinicians also prompted ACP discussions. Data collection was repeated in June 2024. The catchment area is split into North and South, with interventions exclusively in the North.

Results

Data was collected on 136 and 133 patients in December ’23 and June ’24 respectively. Excluding those where ACP was not appropriate left n=93 at both points. Average age 81 years and CFS 6. 

ACP rates improved from 7(8%) to 21(23%) [p<0.001]. CFS was significantly associated with having ACP (OR 1.50; p=0.003), while age not (OR 0.99; p=0.766). 

There was no difference in ACP rates between North and South at baseline. However, ACP increased from 3(5%) to 17(24%) (p<0.001) for the North, with no significant change in South [4(6%) to 4(6%); p=0.54].

Conclusion

The changes in the North, which received training and education highlights how ACP engagement was improved through simple low-cost measures. We believe a culture shift amongst community services can be achieved, so ACP is routinely considered in appropriate patients.