Z LIN JOLENE NG1, A THOENER1
1Coffs Harbour Health Campus, Coffs Harbour, Australia
Aim: To explore a stepwise, team-based approach to the discussion and establishment of advance care directives amongst haemodialysis unit patients in a regional NSW hospital.
Background: The establishment of a formal advance care directive amongst haemodialysis patients remains an informal process, reliant largely on physicians’ and patient’s own initiative.
Methods: A collaborative effort was established between the renal social worker, renal registrar, nephrologist and dialysis unit nurses to facilitate and normalize advance care directive discussions during routine haemodialysis treatment sessions. NSW Health “Making An Advance Care Directive” booklets were provided to patients on a one-on-one basis, along with a 15-20 minute explanation by the renal registrar and renal social worker in person. Patients were encouraged to read through and fill in above booklet with family, carers and return with questions at a tentative date (usually 1 week later) to revisit the completion of booklet. The process was held over a course of six weeks.
Results: Among 32 long-term haemodialysis patients in Coffs Harbour Health Campus, a total of 20 “Making An Advance Care Directive” booklets were provided between March to May 2020. 13 out of the 20 patients returned with a completed advance care directive booklet at the end of 6 weeks. Patients who were excluded either had an established directive, or were deemed unsuitable to participate due to language or capacity barriers.
Conclusions: A systematic, team-based approach could be utilized in advance care planning to ensure provision of appropriate treatment consistent with patient’s wishes.
Dr Jolene Zhuo Lin Ng is a Basic Physician Trainee at the St George – Sutherland Basic Physician Trainee Network in New South Wales, Sydney. She has an interest in glomerulonephritis and hypertension.