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Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study
  1. Karen M Detering1,2,
  2. Kimberly Buck1,
  3. Rasa Ruseckaite3,
  4. Helana Kelly1,
  5. Marcus Sellars1,
  6. Craig Sinclair4,
  7. Josephine M Clayton5,
  8. Linda Nolte1
  1. 1 Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
  2. 2 Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
  3. 3 Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4 Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
  5. 5 Centre for Learning and Research in Palliative Care, Hammond Care, Greenwich Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Karen M Detering; karen.detering{at}


Objectives It is important that the outcomes of advance care planning (ACP) conversations are documented and available at the point of care. Advance care directives (ACDs) are a subset of ACP documentation and refer to structured documents that are completed and signed by competent adults. Other ACP documentation includes informal documentation by the person or on behalf of the person by someone else (eg, clinician, family). The primary objectives were to describe the prevalence and correlates of ACDs among Australians aged 65 and over accessing health and residential aged care services. The secondary aim was to describe the prevalence of other ACP documentation.

Design and setting A prospective multicentre health record audit in general practices (n=13), hospitals (n=12) and residential aged care facilities (RACFs; n=26).

Participants 503 people attending general practice, 574 people admitted to hospitals and 1208 people in RACFs.

Primary and secondary outcome measures Prevalence of one or more ACDs; prevalence of other ACP documentation.

Results 29.8% of people had at least one ACD on file. The majority were non-statutory documents (20.9%). ACD prevalence was significantly higher in RACFs (47.7%) than hospitals (15.7%) and general practices (3.2%) (p<0.001), and varied across jurisdictions. Multivariate logistic regression showed that the odds of having an ACD were positively associated with greater functional impairment and being in an RACF or hospital compared with general practice. 21.6% of people had other ACP documentation.

Conclusions In this study, 30% of people had ACDs accessible and a further 20% had other ACP documentation, suggesting that approximately half of participants had some form of ACP. Correlates of ACD completion were greater impairment and being in an RACF or hospital. Greater efforts to promote and standardise ACDs across jurisdictions may help to assist older people to navigate and complete ACDs and to receive care consistent with their preferences.

Trial registration number ACTRN12617000743369.

  • advance care planning
  • advance care directive
  • prevalence
  • quality in health care
  • clinical audit

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  • Patient consent for publication Not required.

  • KMD and KB contributed equally.

  • Contributors KMD and KB contributed equally to this paper. KMD was involved in the conception, design, data acquisition, analysis and interpretation, and drafting the manuscript. KB was involved in data analysis and interpretation and drafting of the manuscript. RR and HK were involved in the design, data acquisition and review of the manuscript. MS was involved in data analysis and interpretation and review of the manuscript. CS and JMC were involved in the design, interpretation of data and review of the manuscript. LN was involved in the conception, design, data acquisition, analysis and interpretation, and review of manuscript. All authors read and approved the final manuscript.

  • Funding This work was supported by the Australian Government Department of Health.

  • Competing interests None declared.

  • Ethics approval The study was approved by Austin Health Human Research Ethics Committee (ref: HREC/17/Austin/83) and site-specific approval was sought when required.

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

  • Data sharing statement The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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