Authors (including presenting author) :
Lam K1, Lum CM2, Tong C2, Woo J2, Lam CM1, Tsang KW1, Tang M1
Affiliation :
1Department of Medicine and Geriatrics, Shatin Hospital 2CUHK Jockey Club Institute of Ageing
Introduction :
Although early initiation of advance care planning (ACP) in patients with serious diseases can improve the quality of the end-of-life care patients receive and avoid unnecessary medical treatments and hospitalisations, currently ACP discussion is only initiated after the patients have already entered the end-of-life (EOL) stage. According to the survey results conducted in the medical wards in Shatin Hospital, a convalescent and rehabilitation hospital, up to one-third of the patients admitted had chronic severe diseases with more than two hospitalizations in the past six months. Although these patients has a high risk of deterioration and death in one to two years according to the illness trajectory, most have not yet received any structured information on ACP.
Objectives :
To support the HA initiative to promote ACP in patients with serious diseases to improve the quality of care
Methodology :
Setting Two 30-bed medical wards in a convalescent and rehabilitation hospital Inclusion criteria Patient admitted for acute medical disease and has more than two hospitalizations in the past six months due to acute or chronic medical diseases. Intervention Patient and his/her family members were invited to attend a sharing session on introducing the concept of ACP and discussing the choice of treatment in end-of-life care. The goals of care with patients and their families were also explored. Finally, ACP was signed if patients and their families were considered ready to make this decision.
Result & Outcome :
Eighteen sharing sessions were conducted for 107 participants who were the family members of 68 patients admitted during the period January 2021 to November 2021. This is the first program that patients with serious diseases and their family members were provided structured sharing sessions on ACP during their repeated acute hospitalizations, which is good timing to initiate the discussion of ACP. Most participants were aware of the issues in EOL care before the sessions. However, after attending the sessions, they only came to know the formal concept of ACP and the pros and cons of different life-sustaining treatment options. According to the results of the pre-post questionnaires, there was a marked improvement of the knowledge level of the participants (Pre-score at 3.05 out of 5 versus Post-score at 4.32 out of 5, P<0.001). Being inspired during the sessions, eight patients’ family members requested to consider signing ACP for the patients, and ACP was signed for six of them after subsequent assessments in the medical clinic.
