Healthcare providers' experiences with advance care planning and goals of patient care medical treatment orders in residential aged care facilities: an explanatory descriptive study.

Abstract

Advance care planning (ACP) is a process by which people communicate their healthcare preferences and values, planning for a time when they are unable to voice them. Within residential aged care facilities (RACF), both the completion and the clarity of ACP documents are varied and, internationally, medical treatment orders have been used to address these issues. In this study, goals of patient care (GOPC) medical treatment orders were introduced alongside usual ACP in three RACF to improve healthcare decision-making for residents. This study explored the experiences of RACF healthcare providers with ACP and GOPC medical treatment orders. The study used an explanatory descriptive approach. Within three RACF where the GOPC medical treatment orders had been introduced, focus groups and interviews with healthcare providers were performed. The transcribed interviews were analysed thematically. Healthcare providers not only reported support for ACP and GOPC but also discussed many problematic issues. Analysis of the data identified four main themes: enablers, barriers, resident autonomy and advance documentation (ACP and GOPC). Healthcare providers identified ACP and GOPC as positive tools for assisting with medical decision-making for residents. Although barriers exist in completion and activation of plans, healthcare providers described them as progressing resident-centred care. Willingness to follow ACP instructions was reported to be reduced by lack of trust by clinicians. Families were also reported to change their views from those documented in family-completed ACP, attributed to poor understanding of their purpose. Participants reported that GOPC led to clearer documentation of residents' medical treatment plans rather than relying on ACP documents alone.