Abstract CN18
Background
Advanced care planning (ACP) facilitates discussions and recording of key healthcare decisions in end-of-life scenarios. Discussions involving death remained a taboo in Chinese culture and a suitable communication framework is required to facilitate such conversations. Recognition of advance directives (AD) is inconsistent among different healthcare providers (HCP) in Hong Kong.
Methods
Harnessing the virtue of altruism for own family in Chinese culture, a communication framework has been devised, which includes reminding patients (pts) how ACP can relieve stress from their family by obviating the need for making medical decisions for them. The framework was applied on 741 pts who attended our hospice new-case clinic from 2017 to 2019. Outcomes, satisfaction and compliance of HCP to AD were recorded.
Results
Our cohort made up of elderly pts with average age of 74 (range: 36-97) who mainly received elementary/secondary education. ACP discussions were mostly initiated by doctors or nurses (91%). We were able to establish ACP in 81.2% percent of pts, with 63% did so at first encounter. Satisfaction was high, all respondents agree that ACP will help them plan ahead better and 97% agreed that ACP helps to alleviate carer stress. As now, 573 pts has passed away. At their terminal event, 64.7% were admitted to hospice ward, 29.3% in general ward and 6% passed away outside hospital. Eight (1.4%) patients with a valid AD were actively resuscitated, and all happened in emergency setting – 4 of them had cardiopulmonary resuscitation while on ambulance, 3 of them in emergency department, and 1 in home for aged. One patient (0.17%) revoked AD and had CPR in general ward. None of these events happened in hospice ward.
Conclusions
Reminding Chinese patients that setting up an ACP may relieve burden from their family helps to promotes patient involvement in palliative care planning. Despite the cultural taboo on talking about death, pts find ACP useful in helping them plan ahead better, and revocation of AD is rare. Breach of AD due to attempts of CPR mainly happen in emergency setting especially before arriving hospital. Promotion of awareness among emergency HCPs will ensure the will of patients to be followed till the last moment in their lives.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.