Doctors groups have called for urgent investment in training and incentives to address significant concerns over doctors’ poor knowledge of advance care planning.
The Royal Australian College of General Practitioners (RACGP) said it supported advance care planning becoming a routine part of general practice and it had developed learning resources to help GPs, while the Australian Medical Association (AMA) said it supported expanding the Practice Incentive Program to include advance care planning.
The professional bodies were responding to new research which found significant gaps in doctors’ understanding about the legal status of advance care directives and the authority of substitute decision-makers.
As AAA recently reported, the research by Professor Colleen Cartwright from the Southern Cross University found only half of surveyed doctors in New South Wales correctly understood that an enduring power of attorney did not allow the person appointed to make healthcare decisions.
Doctors were also unclear about the order of authority if no enduring guardian had been appointed and did not routinely ask patients if they had undertaken advance care planning options. Professor Cartwright said doctors were leaving themselves open to legal action by not understanding the law in this area.
Dr Liz Marles, president of the RACGP, said alongside improved resources for doctors, the addition of advance care plans to the Personally Controlled Electronic Health Record (PCEHR) would also increase the need for GPs to be knowledgeable in this area.
“This an important area of general practice but understandably GPs find these conversations difficult to have with patients. Doctors do need support in how they do that, and they also need to understand the legal environment and the legal ramifications of their actions,” said Dr Marles.
Dr Brian Morton, chair of the AMA council of general practice, said doctors had an important role to play in promoting the discussion of advance care planning with patients, particularly those over 75, but agreed more support and resources were needed.
“Doctors need continuing education but we also need to be given the tools to provide the counselling to patients and for it to be much more acceptable in society to talk about end of life care issues,” said Dr Morton.
Dr Yvonne Luxford, CEO of Palliative Care Australia, said ongoing education in this area should be compulsory for all healthcare professionals and backed the AMA’s recommendations for financial incentives to support this as a priority area for GPs.
However, she stopped short of endorsing mandatory advance care plans for aged care residents or older patients, saying advance care plans should remain optional.
Both Dr Luxford and Dr Marles said moving to consistent laws and terminology between states and territories would also go some way to reducing the confusion and uncertainty about the legality of advance care plans among medical professionals.
New advisory service
One education initiative currently underway is a $14.8 million project to develop a website and a national hotline for GPs and aged care providers to access specialist palliative care advice and information about advance care planning.
A consortium headed by Palliative Care Australia and Austin Health in Melbourne has been funded under the Living Longer, Living Better reforms to deliver the project.
Dr Luxford said the initiative has a strong focus on upskilling GPs and aged care providers in palliative care and advance care planning, and increasing linkages between aged care and specialist palliative care services.
To identify how the advisory services can be tailored to meet the needs of the sector and what services are currently available, Palliative Care Australia is conducting a survey of aged care providers, GPs and specialist palliative care providers. To express your interest in participating in the survey email: firstname.lastname@example.org
Related AAA coverage: Doctors unclear on advance care planning laws