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Implementation of 'Goals of Patient Care' medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial

Martin, Ruth S., Hayes, Barbara J., Hutchinson, Anastasia, Yates, Paul and Lim, Wen Kwang 2017, Implementation of 'Goals of Patient Care' medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial, BMJ open, vol. 7, no. 3, pp. 1-8, doi: 10.1136/bmjopen-2016-013909.

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Title Implementation of 'Goals of Patient Care' medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial
Author(s) Martin, Ruth S.
Hayes, Barbara J.
Hutchinson, AnastasiaORCID iD for Hutchinson, Anastasia orcid.org/0000-0002-0014-689X
Yates, Paul
Lim, Wen Kwang
Journal name BMJ open
Volume number 7
Issue number 3
Article ID e013909
Start page 1
End page 8
Total pages 8
Publisher BMJ Publishing Group
Place of publication London, Eng.
Publication date 2017-03
ISSN 2044-6055
Keyword(s) Advance Care Planning
End-Of-Life
Medical Treatment Orders
Residential Aged Care Facilities
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
NURSING-HOME RESIDENTS
LIFE-SUSTAINING TREATMENT
ADVANCE DIRECTIVES
PHYSICIAN ORDERS
PROGRAM
INTERVENTION
HOSPITALIZATION
DEMENTIA
OUTCOMES
Summary Introduction Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) ‘Goals of Patient Care’ (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration.

Methods and analysi
s This is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration.

Dissemination The results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area.
Language eng
DOI 10.1136/bmjopen-2016-013909
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution non-commercial licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30093164

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.