{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:07:40Z","timestamp":1765807660029,"version":"3.48.0"},"reference-count":29,"publisher":"BMJ","issue":"1","funder":[{"name":"NSW Ministry of Health: Translational Research Grant"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,11,28]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>It is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Pragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia. Participants will be \u226518 years screened as potentially having palliative care needs and at risk of dying in 6\u201312 months. The patients will be randomised to intervention or control group. Intervention group will undertake ACP discussions facilitated by a trained health professional. The control group will receive written information on ACP, representing the current standard of care. The primary outcome is the number of unplanned hospital admissions at the 6-month follow-up. Secondary outcomes include: (i) patient\u2019s health-related quality-of-life and quality of chronic disease care; (ii) caregiver\u2019s health-related quality-of-life and caregiver burden and (iii) other health outcomes including ambulance usage, emergency department presentations, hospital admissions, resuscitation attempts, intensive care unit admissions, deaths, documentation of patient wishes in patient records and audit of ACP discussions and documents. The staff\u2019s self-reported attitudes and knowledge of ACP will also be measured. The data will be collected using self-report questionnaires, hospital records audit, audit of ACP documentation and data linkage analysis. Semistructured interviews and focus group discussions with patients, caregivers and healthcare professionals will explore the acceptability and feasibility of the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Approved by South-East Sydney Local Health District Human Research Ethics Committee and NSW Population and Health Services Research Ethics Committee. Results will be disseminated via conference presentations, journal publications, seminars and invited talks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ACTRN12617000280303.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-023107","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T06:28:40Z","timestamp":1548397720000},"page":"e023107","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Advance care planning for patients with advanced illnesses attending hospital outpatient clinics study: a study protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"9","author":[{"given":"Joel","family":"Rhee","sequence":"first","affiliation":[{"name":"School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia"},{"name":"Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Meller","sequence":"additional","affiliation":[{"name":"Post Acute Care Services, Prince of Wales Hospital, South Eastern Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolina","family":"Krysinska","sequence":"additional","affiliation":[{"name":"Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Gonski","sequence":"additional","affiliation":[{"name":"Southcare, Sutherland Hospital, South Eastern Sydney, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasi","family":"Naganathan","sequence":"additional","affiliation":[{"name":"Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney and Ageing and Alzheimer\u2019s Institute, Concord Repatriation General Hospital, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Zwar","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Hayen","sequence":"additional","affiliation":[{"name":"Australian Centre for Public and Population Health Research, University of Technology, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Cullen","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie-Ann","family":"O\u2019Keefe","sequence":"additional","affiliation":[{"name":"Aged, Chronic Care & Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"McDonald","sequence":"additional","affiliation":[{"name":"Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Harris-Roxas","sequence":"additional","affiliation":[{"name":"Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gideon A","family":"Caplan","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,1,24]]},"reference":[{"key":"2025121222200010000_9.1.e023107.1","first-page":"815","article-title":"Advance care planning and end of life decision making","volume":"33","author":"Cartwright","year":"2004","journal-title":"Aust Fam Physician"},{"key":"2025121222200010000_9.1.e023107.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.3.359"},{"key":"2025121222200010000_9.1.e023107.3","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1071\/PY08028","article-title":"Advance care planning and quality improvement","volume":"14","author":"Kirsner","year":"2008","journal-title":"Aust J Prim Health"},{"key":"2025121222200010000_9.1.e023107.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c1345"},{"key":"2025121222200010000_9.1.e023107.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2010.03353.x"},{"key":"2025121222200010000_9.1.e023107.6","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afl063"},{"key":"2025121222200010000_9.1.e023107.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.11.1437"},{"key":"2025121222200010000_9.1.e023107.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2014.01.008"},{"key":"2025121222200010000_9.1.e023107.9","unstructured":"National Health and Hospitals Reform Commission. \u00a0A healthier future for all Australians - final report of the National Health and Hospitals Reform Commission. Canberra: National Health and Hospitals Reform Commission, 2009."},{"key":"2025121222200010000_9.1.e023107.10","unstructured":"NSW Ministry of Health. Advance care planning for quality care at end of life. Action plan 2013-2018.: NSW Ministry of Health, 2013."},{"key":"2025121222200010000_9.1.e023107.11","doi-asserted-by":"publisher","DOI":"10.1071\/AH11019"},{"key":"2025121222200010000_9.1.e023107.12","first-page":"213","article-title":"A pilot audit of the process of end-of-life decision-making in the intensive care unit","volume":"9","author":"Zib","year":"2007","journal-title":"Crit Care Resusc"},{"key":"2025121222200010000_9.1.e023107.13","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/32.4.445"},{"key":"2025121222200010000_9.1.e023107.14","doi-asserted-by":"publisher","DOI":"10.1111\/imj.12549"},{"key":"2025121222200010000_9.1.e023107.15","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X06290494"},{"key":"2025121222200010000_9.1.e023107.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2013-000488"},{"key":"2025121222200010000_9.1.e023107.17","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1111\/imj.12550","article-title":"Single-centre cross-sectional analysis of advance care planning among elderly inpatients","volume":"44","author":"Cheang","year":"2014","journal-title":"Intern Med J"},{"key":"2025121222200010000_9.1.e023107.18","unstructured":"NSW Health. Advance care planning: making your wishes known. 2016 http:\/\/www.health.nsw.gov.au\/patients\/acp\/Documents\/making-your-wishes-known.pdf"},{"key":"2025121222200010000_9.1.e023107.19","unstructured":"NSW Health. Making an advance care directive: form and information booklet. 2017 http:\/\/www.health.nsw.gov.au\/patients\/acp\/Pages\/acd-form-info-book.aspx"},{"key":"2025121222200010000_9.1.e023107.20","unstructured":"Public Guardian Office of the NSW Government Department of Attorney General & Justice. Enduring Guardianship in New South Wales. Your way to plan ahead. 2014."},{"key":"2025121222200010000_9.1.e023107.21","unstructured":"NSW Ministry of Health. Using resuscitation plans in end of life decisions.\u00a0Policy directive. 2014."},{"key":"2025121222200010000_9.1.e023107.22","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.5694\/j.1326-5377.2004.tb05947.x","article-title":"Diffusion of innovation theory for clinical change","volume":"180","author":"Sanson-Fisher","year":"2004","journal-title":"Med J Aust"},{"key":"2025121222200010000_9.1.e023107.23","unstructured":"Purdy S , Paranjothy S , Huntley A , et al . Interventions to reduce unplanned hospital admission. Bristol: A series of systematic reviews, 2012."},{"key":"2025121222200010000_9.1.e023107.24","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"2025121222200010000_9.1.e023107.25","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198807000-00007"},{"key":"2025121222200010000_9.1.e023107.26","unstructured":"Ware JE , Sherbourne CD , Davies AR . Developing and testing the MOS 20-item short-form health survey: A general population application. In: Stewart AL , Ware JE , edn. measuring functioning and well-being: the medical outcomes study approach. Durham, NC: Duke University Press, 1992:277\u201390."},{"key":"2025121222200010000_9.1.e023107.27","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000160375.47920.8c"},{"key":"2025121222200010000_9.1.e023107.28","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/41.5.652"},{"key":"2025121222200010000_9.1.e023107.29","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1071\/PY15174","article-title":"A self-reported survey on the confidence levels and motivation of New South Wales practice nurses on conducting advance-care planning (ACP) initiatives in the general-practice setting","volume":"23","author":"Fan","year":"2017","journal-title":"Aust J Prim Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-023107","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:20:08Z","timestamp":1765606808000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-023107"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,24]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1136\/bmjopen-2018-023107"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-023107","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2019,1]]}}}