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Patient-centred medicine
Protocol
Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: a study protocol for a randomised controlled trial
  1. Joel Rhee1,2,
  2. Anne Meller3,
  3. Karolina Krysinska2,
  4. Peter Gonski4,
  5. Vasi Naganathan5,
  6. Nicholas Zwar6,
  7. Andrew Hayen7,
  8. John Cullen8,
  9. Julie-Ann O’Keefe9,
  10. Julie McDonald2,
  11. Ben Harris-Roxas2,
  12. Gideon A Caplan10
  1. 1 School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
  2. 2 Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 Post Acute Care Services, Prince of Wales Hospital, South Eastern Sydney, Sydney, New South Wales, Australia
  4. 4 Southcare, Sutherland Hospital, South Eastern Sydney, Sydney, New South Wales, Australia
  5. 5 Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney and Ageing and Alzheimer’s Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
  6. 6 Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
  7. 7 Australian Centre for Public and Population Health Research, University of Technology, Sydney, New South Wales, Australia
  8. 8 Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia
  9. 9 Aged, Chronic Care & Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
  10. 10 Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Associate Professor Joel Rhee; jrhee{at}uow.edu.au

Abstract

Introduction It is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being.

Methods and analysis Pragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia. Participants will be ≥18 years screened as potentially having palliative care needs and at risk of dying in 6–12 months. The patients will be randomised to intervention or control group. Intervention group will undertake ACP discussions facilitated by a trained health professional. The control group will receive written information on ACP, representing the current standard of care. The primary outcome is the number of unplanned hospital admissions at the 6-month follow-up. Secondary outcomes include: (i) patient’s health-related quality-of-life and quality of chronic disease care; (ii) caregiver’s health-related quality-of-life and caregiver burden and (iii) other health outcomes including ambulance usage, emergency department presentations, hospital admissions, resuscitation attempts, intensive care unit admissions, deaths, documentation of patient wishes in patient records and audit of ACP discussions and documents. The staff’s self-reported attitudes and knowledge of ACP will also be measured. The data will be collected using self-report questionnaires, hospital records audit, audit of ACP documentation and data linkage analysis. Semistructured interviews and focus group discussions with patients, caregivers and healthcare professionals will explore the acceptability and feasibility of the intervention.

Ethics and dissemination Approved by South-East Sydney Local Health District Human Research Ethics Committee and NSW Population and Health Services Research Ethics Committee. Results will be disseminated via conference presentations, journal publications, seminars and invited talks.

Trial registration number ACTRN12617000280303.

  • geriatric medicine
  • advance care planning
  • outpatient clinic

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-023107

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors JR, AM, GAC, PG and NZ conceived the study. JR, AM, GAC, PG, VN, NZ, AH, JC and J-AOK wrote the study protocol. AH designed the statistical analysis plan for the protocol. JR, AM and KK designed the implementation aspects of the protocol. JMcD and BH-R made substantial contributions to the study design. KK and JR were responsible for drafting the manuscript. All authors read, provided important revisions and approved the final version of the manuscript.

    • Funding This work was supported by the NSW Ministry of Health: Translational Research Grant number 143.

    • Competing interests None declared.

    • Ethics approval South-East Sydney Local Health District Human Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.