LSE study identifies promising ways to deliver advance care planning support at scale

Provision of advance care planning support has been limited and patchy, with pressure on staff time a significant barrier.
- Josie Dixon

A study led by the Care Policy and Evaluation Centre at the London school of Economics and Political Science (LSE)  is one of the first to examine real-world delivery of advance care planning support on a large scale internationally.  

The studyDelivering Advance Care Planning Support at Scale: A Qualitative Interview Study in Twelve International Healthcare Organisations, has been published in the Journal of Long-term Care. Findings identify several promising ways of delivering advance care planning support for people efficiently and effectively on a large scale.

Advance care planning is the process of a person making choices and decisions about their future healthcare. This usually involves discussion with, or support from, a health or care professional. Although anyone can undertake advance care planning at any time, it’s particularly important for people living with chronic and progressive illnesses.

Josie Dixon, who led the research, said: “The right to a say in one's end of life care is set out in UK policy and legislation with an emphasis on early conversations and advance care planning in the case of progressive and terminal illness. However, in practice, we know provision of advance care planning support has been limited and patchy, with pressure on staff time a significant barrier.”

In-depth interviews were carried out with a range of leaders and frontline staff from 12 international healthcare organisations in Australia, Canada, New Zealand and the US. The purpose of these interviews was to understand the aims of the different organisations and leaders’ perspectives on the economic case for advance care planning. The research also aimed to identify the most promising approaches for efficiently and equitably delivering advance care planning support at scale.

Commenting on the study findings Josie Dixon added, “We found a complex picture. Advance care planning is being provided both as an individual-level intervention and as part of wider system change, needed because of people living longer, increases in chronic progressive illness and frailty and in the availability and use of medical interventions in the late stages of illness.

“Leaders we spoke to thought the economic case was probably too difficult to quantify, but pointed to quality improvements for patients and families, managing organisational risks associated with ongoing demographic and technological changes, and limiting reactive care and the use of low-value treatments.”

The interviews showed that the organisations shared challenges in delivering advance care planning support, particularly with regard to the demands on staff time.

The findings from the study identify several areas in which efficiencies can be sought to enable the delivery of advance care planning support at scale. Promising areas for development included a degree of staff specialism, physicians working in teams with trained nurses or social workers, the use of decision aids, group-based facilitations, strengthened public health approaches and supportive parallel system changes.

Behind the article

Delivering advance care planning support at scale: A qualitative interview study in twelve international healthcare organisations by Josie Dixon and Martin Knapp was published in the Journal of Long-term Care and funded by the NIHR School for Social Care Research