FC36: Advance care planning with older people living with psychosis- preliminary findings regarding the experiences and attitudes of mental health clinicians with a view to implementation strategy

Abstract

Objectives: Older people living with mental illness, including schizophrenia and other psychotic disorders, experience increased physical morbidity and premature mortality rates compared to the general population. However, Advance Care Plans (ACP) are rarely documented in this group, despite ability to discuss end-of-life care and express wishes. The aim of this study is to explore mental health clinicians’ attitudes, experiences, and perceived barriers and facilitators to ACP with people living with psychotic illnesses, to better understand the reasons for this gap and develop a needs-responsive approach toimplementation.

Methods: This qualitative study involves focus groups of multidisciplinary mental health clinicians who work with people aged 55+ with psychotic illnesses. It is being conducted in three public mental health services in Sydney, Australia. Focus groups are audio-recorded, transcribed and analysed using reflexive thematic analysis, grounded within an interpretive description framework.

Results: Preliminary findings from an unsaturated sample of 12 multidisciplinary clinicians (psychiatrists, social workers, occupational therapists, psychologists) will be presented. Emerging themes regarding experiences of ACP include ‘no experience’, ‘not a priority’, ‘particular relevance for nursing home residents’ and ‘difficult to navigate consumer choices in the context of delusions’. Emerging themes in relation to attitudes about implementing ACP with people with psychotic illnesses include: ‘ACPs are needed’, ‘ambivalence’, ‘I don’t know how’, and ‘whose responsibility are ACPs?’. Barriers to ACP include: ‘misconceptions about ACP’, ‘misperceptions about psychotic illness’, ‘clinician uncertainty- capacity, emotional state, psychosis risk’, ‘systems issues’, ‘lack of knowledge and confidence’, and ‘interfering with therapeutic relationships’. Potential facilitators include: ‘get the timing right’, ‘make it multidisciplinary’, ‘opportunity to practice’, ‘embed in protocol’, ‘upskilling clinicians- modelling and training’, and ‘support from an external ACP role’.

Conclusions: Mental health clinicians may be the only healthcare professional in contact with an older person living with psychosis, providing unique opportunities to explore ACP. Clinicians recognise the need for ACP, the complexity of such Discussions, and importance of nuanced capacity assessment and appropriate timing. Proposed solutions to implementing ACP include combining targeted education with practical training for clinicians, embedding ACP in practice using a team approach and system change, or -alternatively-through a dedicated external ACP role.