clinical practice
Beginning of the end
Nurses take the lead in encouraging Advance Care Planning .
By Elise Hartevelt
Nurses advise patients about Advance Care Planning two decades earlier than GPs , a study has found .
ACP gives people the opportunity to write down their preferences for their future health care .
Behavioural scientist Dr Stephen Whyte from Queensland University of Technology ’ s Behavioural Economics Society and Technology department partnered with Professor Patsy Yates and Joanna Rego from QUT ’ s Faculty of Health to look at how patients go about addressing ACP .
“ Planning the end of your life or your healthcare in a significant health event is a pretty large decision ,” Whyte says .
“ Understanding how GPs , nurses and patients perceive , engage , and choose to communicate about ACP and end-of-life ( EOL ) decisions is critical for increasing future uptake and efficient future healthcare provision .”
Yet , data suggests that only 14 per cent of the Australian population has documented an ACP .
“ We found one of the main reasons the uptake of ACP is so low is a lack of patient
22 | nursingreview . com . au knowledge . Even when older people express clear preferences for future EOL care , healthcare communications are often inadequate .”
Whyte looked at how to help patients better understand the process of ACP and how doctors and nurses can assist them in making the best decision for themselves .
The catalyst to instigate ACP is often a significant health event , such as a diagnosis of a severe illness .
However , Whyte emphasises that planning your future healthcare is relevant for all ages , regardless of sickness .
“ Interestingly , our study shows most people and GPs consider it apt to start such a discussion in the late 50s ,” Whyte says .
“ Nurses , on the other hand , consider it a priority from a person ’ s early 40s , probably because they are the ones most involved in the day-to-day provision of EOL care .”
According to Whyte , nurses are on the frontline of informing patients about ACP because “ they ’ re already highly engaged ”. “ They ’ re the ones bringing it to the fore .” Who advises the patient during the ACP decision-making process has shifted over the past year in health care , the study noted .
Whereas patients used to prefer an authoritarian structure , such as the doctor in charge , the standard has now
“ It can improve the quality of their end-of-life experience .
become a shared decision-making model , where patients are included in the process .
“ It ’ s hard because it ’ s a sort of patriarchal model where you have this informed expert that ’ s trying to give advice and you have a novice patient who can ’ t possibly , even if they wanted to , completely understand the gravity of all of the processes and risks involved ,” Whyte explains .
Instead , he suggests that we should change our overall perspective of speaking about ACP .
“ In almost all facets of life , we tend to use either the carrot or the stick , like ‘ Don ’ t speed in your car , you ’ ll get a fine ’.
“ We advertise to people about their behaviour in either encouraging them with a positive instrument or discouraging them with a negative of the stick .
“ Selling it as a positive to them is a much better way to approach it because people will engage with it more .” For Whyte , the benefits of ACP are clear . “ It can improve the quality of their endof-life experience , ensure their wishes are explicitly met , and alleviate stress and anxiety for loved ones .” ■