A cross-sectional study assessing concordance with advance care directives in a rural health district

To measure compliance with Advance Care Directives (ACDs) for decedents in a rural setting.

Observational, cross-sectional medical records audit comparing requests in ACDs with actual outcomes.

Rural Australian coastal district.

People who had an ACD, died during the study period (30 May 2020 to 15 December 2021) and participated in a local research project.

Compliance was measured by comparing stated requests in the ACD with outcomes recorded in medical records. This included the place of death and a list of 'unacceptable interventions'.

Sixty-eight people met the inclusion criteria (age range of 46-92 [mean 67 years; median 74 years]; 42 [62%] male). The main cause of death was cancer (n = 48; 71%). Preferred place of death was not stated in 16 ACDs. Compliance with documented preferred place of death was 63% (33/52): 48% (16/33) when the preferred place of death was home; 78% (7/9) when sub-acute was preferred; and 100% (10/10) when hospital was preferred. Compliance was 100% with 'unacceptable interventions'.

These results demonstrate strong compliance with rural patients' requests in ACDs, particularly 'unacceptable interventions'. Home was the most common preferred place of death, but the compliance measure (48%) was the lowest in this study. This requires further exploration.