Authors (including presenting author) :
Chan SS(1),Lee CK(1),Soong IS(1),Mung ST(1),Shiu CK(1),Chan K(1),Lau OY(1), Yeung MWR(1),Au WY(1)
Affiliation :
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital
Introduction :
Advance Care Planning(ACP) refers to the planning, for a patient who has a serious illness, on future medical and personal care at the end-of-life through the discussion and planning process among the patient, family and healthcare workers taking into consideration factors, such as disease prognosis, benefits and burdens of treatment, values and preferences of the patient (Hospital Authority, 2015) A longitudinal study in Hong Kong conducted between 2016 and 2018 found that the awareness of advance directives(AD) among general public and medical professionals had increased. In April 2018, we established the ACP clinic to identify patients and families who are ready and suitable for introducing the ACP concept and subsequent discussion. The ACP clinic is essentially a nurse-led clinic running by both the palliative care nurse and social worker. An ACP booklet bearing discussion material on various dimensions on life was also developed to facilitate the ACP process. Wishes and preferences of the patients were explored. Doctors would be involved if patients expressed their wishes on making advance directives(AD), Do-Not-Attempt-Cardiopulmonary-Resuscitation(DNACPR) at the terminal phase of life and medical treatment options. Reviews on the documentation and dissemination of patient’s wish would be made regularly
Objectives :
A review of ACP clinic service was done on exploring, planning and documenting the patients’ preferences near their end-of-life.
Methodology :
Evaluation period is from April 2018 to December 2019, a comprehensive questionnaire was designed and telephone contact were made to assess the effectiveness in stating patient’s end-of-life wishes and the impact of ACP clinic.
Result & Outcome :
Seventy-eight patients were recruited to the ACP clinic. 66.7% (N=52) attended the clinic. All patients attended could have their wish of care preference at the end-of-life documented and completed part or all of the ACP process. The questionnaires also showed that family discussion related to the healthcare preference, values, aftermath arrangement was facilitated. 69.2% (N=36) patients expressed their wish and signed off the AD and DNACPR forms. Satisfaction rate was high(85.7%) regarding family perception of patient’s death. Conclusions: The pilot service of ACP clinic facilitated patients to make their choices and enabled the communication with their families and healthcare workers. This service review also helped to refine the criteria for selecting patients to the ACP clinic in the future.
