Advance care directive documentation: issues for clinicians in New South Wales

Objective. The aim of the present study was to assess the characteristics of documents presented as advance care directives (ACDs) at a public health organisation in New South Wales (NSW). It was envisaged that the findings would inform the refinement of locally developed educational strategies. Methods. All ACD documents provided during hospital admissions and entered into the electronic medical record system over a 12-month period were reviewed. An audit tool was developed and used to identify whether key requirements for ACDs in NSW had been addressed. Results. Of the 100 ACDs that were reviewed, only 50 were assessed as being valid to inform future clinical scenarios. Multiple templates with different designs and of varying length had been used. Conclusions. Documents identified as ACDs may carry doubt about their validity. Clinicians require education about differences in template formats, the application of content to clinical decisions and associated legal responsibilities. What is known about this topic? Advance Care Directives in NSW exist without a specific legislative framework or prescriptive format. Clinicians are presented with a wide variety of documents with broad variance in content. What does this paper add? This paper describes the variance found within ACDs in detail, and identifies concerns about validity that healthcare systems need to consider. What are the implications for practitioners? Clinicians need to discern the validity and utility of ACDs before the content is used in the process of clinical decision-making.