The Prevalence and Use of Advance Health Directives (AHD’s) in Promoting Patient Autonomy at End-of Life
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Effective and inclusive end-of-life planning can improve care of the dying patient; reduce patient anxiety about death, and aid bereavement for surviving relatives. Clarity in end-of-life care may also reduce the distress felt by clinical staff through reducing unwanted or futile medical interventions that are a known source of moral distress particularly for nursing staff. Ensuring that patient wishes are heard, documented and effectively managed within healthcare organisations, therefore, has potential to deliver great benefits for patients, health care staff, and the overall organisational climate. In Queensland, the Advance Health Directive (AHD) is a legally binding document that enables people to document their end-of-life care wishes in the event that they lack capacity to make their wishes known. Typically, AHD's include patient instructions to health carers with respect to initiating/withholding resuscitation, artificial feeding and hydration, the administration of antibiotics, and the use of life sustaining measures such as ventilation at end-of-life. Directions documented in an AHD take precedence over the opinion of any other substitute decision maker, including an appointed guardian, a nominated EPOA, or Statutory Health Attorney. The AHD is, therefore, potentially a powerful legal document that can support patient autonomy at end-of- life, and reduce futile interventions. While the AHD is a significant legal document in the management of end-of-life care little is known about its actual prevalence, contents or management in the acute care hospital setting. This paper will present data from a study in which a retrospective chart audit of over 2500 charts in a Queensland tertiary referral hospital to determine the (previously unknown) prevalence and management of AHD's. In this paper, we examine potential reasons for the very low prevalence (0.5%) and high numbers of invalid documents found. We further explore why the AHD appears under-utilised as a means of supporting patient autonomy at end-of-life. Potential areas of organisational reform concerning the promotion, management and more effective use of EOL advance planning will also be addressed.
2010 Gold Coast Health and Medical Research Conference
Law not elsewhere classified