O-123 How do we measure successful advance care planning?

Abstract

Background A consensus concerning what constitutes successful advance care planning (ACP) does not currently exist. Completion of advance directives and healthcare utilisation has traditionally been used to measure successful ACP. Although these outcomes are important and often easily obtained from medical records, ACP is more complex. Many patients may engage in ACP without completing a directive, and greater utilisation may be in line with patients’ preferences. In addition, measuring the process of ACP (an upstream outcome) is also important as evidence suggests that the process involves a series of multiple discrete behaviours for which people are in varying stages of behaviour change. For downstream clinical outcomes, the gold standard of ACP is whether the care received is consistent with patients’ goals; a notoriously difficult outcome to measure and standardised across studies. Aims The aims of this talk are: (1) to describe why advance directives and healthcare utilisation should not be the only markers of successful ACP; (2) to describe the creation and validation of a survey designed to measure the process and behaviour change constructs of ACP; (3) to discuss why it is difficult to measure care consistent with patients’ goals; and (4) to describe and provide preliminary results from an international Delphi Panel designed to standardise ACP outcomes. Discussion Measuring ACP is complex. It includes upstream process outcomes and downstream clinical outcomes, such as care consistent with goals. A large international Delphi panel is underway to help standardise this process across studies and to help define successful ACP for the field.