As Australia’s population ages, nurses are recommending people start putting in place advance care planning in their early 40s, 15 years earlier than GPs suggest and the public deems necessary, according to a new report. QUT study.
The results, which also indicate that people think their doctors should play a greater role in the decision-making process, while doctors think they should play less, are reported in the article Cognitive & Behavioral bias in Advance Care Planning, published by the Journal of Palliative Care and Social Practices.
Behavioral economist Dr. Stephen Whyte, Research Fellow and Deputy Director of the Center for Behavioral Economics, Society and Technology (BEST Center) at QUT, said that how we make decisions to plan our future health varies for each individual, but that behavioral economics was a useful tool for identifying factors. important in the process.
“Understanding how GPs, nurses and patients perceive, engage and choose to communicate about Advance Care Planning (ACP) and End of Life (EOL) decisions is critically important to increasing the future uptake and future effectiveness of health care delivery,” Dr. Why said.
“ACP enables people to clearly express their desires, wishes and preferences for their future healthcare needs to family, friends and healthcare professionals.
“Yet the data tells us that only 14% of the Australian population currently has an advance health directive in place.”
Dr Whyte said the issue would become increasingly important as the Federal Government reports that the number of Australians aged 65 and over has fallen from 8.3% of the total population in 1970 to 16% in 2020, with this figure expected to rise to between 21 and 23% by 2066 (source: Australian Institute of Health and Welfare) – one in five people will be aged 85 and over.
“The benefits are clear. For the affected person, it can improve the quality of their end-of-life experience and ensure their wishes are explicitly met, as well as relieve stress and anxiety for loved ones,” Dr Whyte said.
“It can also significantly reduce the psychological, emotional, administrative and economic burden on healthcare professionals and systems.
“We found that one of the main reasons why ACP uptake is so low is lack of patient knowledge and even when older adults express clear preferences for future end-of-life care, communications resulting health care is often inadequate.
“Some critics argue that the current EOL shared decision-making model is flawed because in real-world situations there will always be a degree to which they will be incomplete as advice from medical experts can bias a patient’s choices.
“Furthermore, the ability to make autonomous choices is further compromised when complex care is required.
“Further research is needed to understand the factors influencing decision-making in ACP countries, but behavioral economics can certainly offer insight beyond the traditionally restricted cost-benefit analysis.
“We can integrate the effects and impact of cognitive, emotional, psychological and socio-cultural factors into individual and organizational decision-making. These research methods have proven effective in exploring the communication and behaviors of medical experts and patients in a range of allied health settings, including pharmacy, reconstructive surgery, and breast nursing.
The researchers collected data from 1,253 members of the Australian public aged between 18 and 80, as well as 117 nurses and general practitioners.
“Previous research in this area has primarily focused on samples from critically ill and/or elderly populations, and has not explored the role of bias in decision-making,” Dr. Whyte said.
“Our study provides new and novel empirical findings from both frontline healthcare professionals and potential future patients regarding ACP communication and preferences.
“Triggers for engaging in a discussion about ACPs are usually related to a significant, new or ongoing health issue.
“Interestingly, our study shows that most people and general practitioners consider it appropriate to start such a discussion in the late 1950s. Nurses, on the other hand, see it as a priority as early as early quarantine, likely because they are most involved in day-to-day end-of-life care.
“We also found worrying inconsistencies in how choices are influenced.
“The findings provide evidence to support other ways to increase PCA awareness through targeted communications based on the identification of key group preference differences, as well as the need for future applied behavioral research in this critical healthcare decision-making space.”
Dr Whyte’s co-authors on the paper are Professor Emeritus Patsy Yates, Executive Dean of QUT’s Faculty of Health, Dr Joanna Rego of QUT’s School of Nursing, Researcher Dr Ho Fai Chan and the Professor Uwe Dulleck, Director of QUT’s Center for Behavioral Economics, Society and Technology (BEST Center) and Professor Raymond Chan of Flinders University.
Read the full study online Cognitive and behavioral biases in advance care planning – Stephen Whyte, Joanna Rego, Ho Fai Chan, Raymond J. Chan, Patsy Yates, Uwe Dulleck, 2022 (sagepub.com)
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