Evaluation of the Implementation of the Advance Care Planning Package in South Western Sydney

Abstract

Aims and Objectives: To develop an understanding of the implementation of the Community-Criteria for Screening and Triaging to Appropriate aLternative care (C-CriSTAL) initiative in primary healthcare setting in South Western Sydney (SWS). Background: C-CriSTAL is a prognostic assessment tool that identifies elderly patients at the end-of-life (EOL), quantifies the risk of imminent death and facilitates discussion on care preferences. A General Practice co-designed initiative C-CriSTAL was developed which included an advance care planning implementation package (ACPIP) with the components of early detection, identification of EOL care needs and communication with the patient in primary healthcare setting. Design: Qualitative study. Methods: Semi-structured interviews were conducted with purposive sample of Executive Sponsor and members of the Clinical Reference Group including representatives from a Local Health District, C-CriSTAL Project Team, a Primary Health Network, Consumer, General Practitioners. The Interviews were recorded, transcribed verbatim and analysed qualitatively by means of a thematic analysis. Results: A total of 12 interviews were conducted. Thematic analysis resulted in identification of three salient themes: 1) Success elements; 2) Facilitators; and 3) Future Enablers. These salient themes capture facilitators and barriers to the program’s implementation and ability to become part of routine practice. Conclusions: The C-CriSTAL initiative in SWS was well accepted and perceived as valuable and beneficial for patient’s health care. The tool enhanced clinician’s confidence in initiating earlier EOL discussions and empowered patients to express EOL wishes in a comfortable environment then subsequently documented in the form of an advance care directive (ACD). However, challenges to sustain the program as a whole in the longer term were evident due to issues of time, funding, education/training for staff. Relevance to Clinical Practice: This study provides insight into the practical considerations as well as barriers and facilitators to the implementation of C-CriSTAL package in primary healthcare setting.