Advance care planning: empowering older frail people to document their end of life wishes

Objective To determine the features that are required to increase uptake of advance care directives (ACDs). Methods We conducted a study involving older patients attending aged care outpatient clinics and/or receiving outreach services between March 2021 and December 2022. Patients were assessed using tools related to frailty, end of life and empowerment. If the person agreed to complete an ACD, they were guided through it, and it was subsequently uploaded on the electronic medical record. Results Of 170 patients referred to complete an ACD, 47% completed it. These patients had lower Rockwood Clinical Frailty Scale and SPICT (Supportive and Palliative Care Indicators Tool) scores. The Frailty and SPICT tools were easier to use, the PAM (Patient Activation Measure) was difficult to use and assess. Patients did, however, show satisfaction in the process. Conclusions Patients completing an ACD tended to be a little less frail and less likely to die in the following 12months. Increased uptake of ACD is more likely if the less frail are targeted, and assisted through the process by a health professional at a time and place that suits the person.