Advance care planning by proxy for residential aged care facility residents: results of a pilot interventional study

Advance care planning (ACP) allows people with decision-making capacity (DMC) to stipulate their wishes for medical treatment if they lose this capacity. However, many lose DMC before expressing their treatment wishes. Supplementary ACP models, conducted with health care proxies (HCPs), could promote care that is as coherent as possible with the presumed wishes of people who have lost medical DMC. This study pilot-tested an ACP-by proxy (ACP-bp) intervention with HCPs of residential aged care facility (RACF) residents lacking medical DMC to examine the acceptability and feasibility of the intervention.

21 HCPs of 20 RACF residents participated in this multi-method evaluation of a single-arm intervention pilot study. Proxy decisional conflict and facilitator (RACF health professionals) self-efficacy were measured pre- and post-intervention. Semi-structured interviews were conducted with HCPs and facilitators. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically.

The intervention significantly reduced proxy decisional conflict. Feasibility was threatened by health professional, proxy, and physician time, and RACF health professional turnover. Proxies and facilitators indicated that ACP-bp promoted in-depth discussions of residents' lives, thereby improving health professionals' knowledge and connection with residents, as well as proxy confidence. It promoted communication and cooperation between proxies and health professionals and provided clear documentation in case of emergency.

The intervention was acceptable for all participants. Future research should focus on the most efficient models for implementing ACP-bp and establish their validity in promoting care that is coherent with patient wishes through a cluster randomized control study.

NCT04779684.