Implementing Advance Care Planning in ‘The Age of Deferred Death’ - the Hong Kong Experience over 4 Years

OBJECTIVES: To plan, implement and evaluate a series of initiatives to improve patient centred quality of end of life care through raising public awareness, promoting the concept that all health and social care professionals should be engaged in this practice, and carrying out pilot of community care models. DESIGN: Pilot studies of community models of care, training programs for health and social care professionals, public education programmes. SETTING: Selected hospitals, residential care homes for the elderly, and community centres in Hong Kong. PARTICIPANTS: Patients and their families at the end of life stage. MEASUREMENTS: Combination of quantitative and qualitative studies according to different components of the initiative. RESULTS: Effective training for professional staff occurred using training videos, role play, rather than lectures, and when concepts are integrated into daily practice and quality assurance programmes. Members of the public welcomed end of life care discussions and the implementation of advance care planning. The pilot community care program was found to reduce anxiety, depression, physical symptoms, improve communication within the family as well as promoting a feeling of peace among recipients of the service. It also reduced care giver strain and anxiety, as well as hospital visits and duration of stay. Similar findings were also observed among recipients of care in the residential care setting. CONCLUSION: A sustainable model would require uptake by policy makers and chief executives of Social Welfare and Health Bureaus, supported by amendments of relevant legal ordinances, which is in progress after public consultation.