A cross-sectional study assessing concordance with advance care directives in a rural health district

Objective: To measure compliance with Advance Care Directives (ACDs) for decedents in a rural setting. Design: Observational, cross-sectional medical records audit comparing requests in ACDs with actual outcomes. Setting: Rural Australian coastal district. Participants: People who had an ACD, died during the study period (30 May 2020 to 15 December 2021) and participated in a local research project. Main Outcome Measure(s): Compliance was measured by comparing stated requests in the ACD with outcomes recorded in medical records. This included the place of death and a list of ‘unacceptable interventions’. Results: Sixty-eight people met the inclusion criteria (age range of 46–92 [mean 67 years; median 74 years]; 42 [62%] male). The main cause of death was cancer (n = 48; 71%). Preferred place of death was not stated in 16 ACDs. Compliance with documented preferred place of death was 63% (33/52): 48% (16/33) when the preferred place of death was home; 78% (7/9) when sub-acute was preferred; and 100% (10/10) when hospital was preferred. Compliance was 100% with ‘unacceptable interventions’. Conclusion: These results demonstrate strong compliance with rural patients' requests in ACDs, particularly ‘unacceptable interventions’. Home was the most common preferred place of death, but the compliance measure (48%) was the lowest in this study. This requires further exploration.