Life In The Slower Lane

Here is the PICO analysis for the fifth uploaded article:

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✅ PICO Analysis

Full Article Title:

The advance care planning nurse facilitator: describing the role and identifying factors associated with successful implementation

Type of Study:

Qualitative implementation evaluation (nested within a randomised patient-preference trial)

Journal and Year:

Australian Journal of Primary Health (2019); 25:564–569

DOI: 10.1071/PY19010

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P – Population

• Setting:
  • Metropolitan tertiary hospital and rural primary/secondary care settings (including general practice clinics, regional hospitals, and residential aged care facilities [RACFs]) in Western Australia
• Participants:
  • Patients with severe respiratory disease (identified as being at high risk of death within 12 months)
  • 17 health professionals interviewed, including nurse facilitators, GPs, hospital and primary care clinicians
• Patients:
  • 266 referred, 215 confirmed eligible, 149 consented, 106 allocated to intervention, 89 completed ACP discussions 

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I – Intervention

• Type:
  • Nurse-led ACP facilitation model within a randomised trial
• Description:
  • Two experienced nurse facilitators (part-time) trained in ACP delivery
  • Conducted patient screening, facilitated ACP conversations, supported documentation, and coordinated with treating clinicians
  • Undertook outreach in preferred patient settings (home, GP clinic, RACF)
  • Supported by structured protocol, checklists, and specialist team access
  • ACP included family involvement, repeat discussions as needed, and documentation management

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C – Comparison

• Control:
  • Patients allocated to usual care in the randomised trial
• Note:
  • This paper focuses only on the implementation evaluation; outcomes from the RCT are reported separately (Sinclair et al., 2017)

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O – Outcomes

Primary Outcomes (as implementation factors):

1. Successful ACP Implementation Factors:
   • Trusting relationships between nurse facilitators and GPs
   • Delivery in primary care setting or home (non-acute environments)
   • Designated time and flexibility to conduct in-depth discussions
   • Clinical credibility and communication skill of facilitators
   • Familiarity with patient, holistic care understanding
2. Barriers to ACP in Acute Settings:
   • Patient acuity and stress
   • Clinician time constraints
   • Limited opportunity for meaningful encounters during hospitalisation
3. Nurse Facilitator Contributions:
   • Patient identification and screening
   • Prompting treating clinicians to consider ACP
   • Conducting full ACP conversations and supporting documentation
   • Educating staff and supporting integration of ACP into care routines

Outcome Classification:

• Person-centred outcomes: Greater opportunity for meaningful ACP; improved patient readiness; discussions in patient-preferred settings
• Process outcomes: More efficient identification of eligible patients; improved collaboration between teams; better documentation
• System outcomes (indirect): Increased ACP uptake (documented in linked trial), potential reduction in hospital admissions and goal-discordant care 

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