Strengthening advance care planning in rural residential aged care through multidisciplinary educational case conferences: A hybrid implementation-effectiveness study

Abstract

Strengthening advance care planning in residential aged care is now a priority. This hybrid implementation-effectiveness study aimed to implement and evaluate the effectiveness of multidisciplinary educational case conferences (MuDECC) in end-of-life planning in two Australian rural residential aged care facilities. MuDECCs are hour long meetings with the resident (where appropriate), their family/guardian and a multidisciplinary team of healthcare providers (including community pharmacists) to discuss and plan for the resident’s future end-of-life care needs. Between November 2018 and July 2019 ten MuDECCs were convened. The implementation was evaluated using a utilisation-focused approach. Intervention outcomes were documented advance care plans, availability of anticipatory end-of-life medications, and participant satisfaction. Of 23 persons who died during the study period, 65% had a documented end-of-life care plan; 57% had anticipatory medications charted. MuDECCs were reported to be acceptable, effective, and a valuable learning experience. By providing a framework for informed decision making and joint problem sharing, MuDECCs were effective in facilitating advance care planning and prescribing of anticipatory medications. However, MuDECCs were time consuming to organise with disproportionate responsibilities or time commitments borne by several key individuals. The necessary personal and professional capital to implement MuDECCs may be limited or unavailable in some rural locations.