This desktop/scoping document review examined policy documents accessible on the intranet sites of 15 New South Wales (NSW) Local Health Districts (LHDs) to determine differences in availability, content, definitions, and terminology related to end-of-life planning.
The stated objective was to identify documents that described elements of or were relevant to end-of-life planning and to characterise variation across jurisdictional and facility levels.
The authors performed a desktop/scoping comparative analysis of documents identified from the 15 NSW LHD intranet sites. Documents that pertained to end-of-life planning were selected for extraction and analysis. The READ approach was used to structure data extraction and analysis; the source abstract reports the use of this framework but does not detail the individual READ steps within the abstract.
A total of 105 documents were retrieved. Of these, 49 documents (46% of the total) were identified as discussing or mentioning resuscitation plans, advance care plans, or advance care directives. The 49 relevant documents were further classified by level:
These counts are reported in the study abstract and form the basis for the review's comparative analysis.
The frequency of key terms and definitions among the 49 documents was reported as follows:
The review identified significant variation in terminology and in the use of abbreviations across the documents. The authors note inconsistency document-to-document in both wording and conceptual definitions relevant to end-of-life planning.
The abstract reports that a greater proportion of the documents did not align with the state policy PD_2014_030. The specific areas of misalignment (for example, definition differences, procedural discrepancies, or formatting) are not detailed in the abstract; those specifics would be found in the full text. The finding indicates discrepancy between local/facility documentation and the referenced state policy.
Using the Australian Statistical Geography Standard Remoteness Structure, the authors report differences in availability and accessibility of documents according to remoteness. Reported distributions were:
These figures indicate a concentration of accessible documents in major cities and fewer available documents in inner/outer regional and remote areas.
The review highlights several key findings:
There is variation in the number and type of end-of-life planning documents available across LHDs and between facility and state levels.
Terminology, definitions, and abbreviations for core concepts such as advance care plan, advance care directive, and resuscitation plan vary between documents.
A substantial proportion of documents did not align with the state policy PD_2014_030, suggesting a potential gap between state-level guidance and local practice or documentation.
Document availability is uneven geographically, with a majority of documents located in major cities and fewer in regional and remote settings.
From these findings the authors conclude that current statewide policies may not be adequately meeting the needs of LHDs and hospitals at the local level. They emphasise the importance of accepted, uniform definitions within statewide policymaking to reduce inconsistency and support clinical practice.
The abstract presents a focused comparative document review limited to documents accessible via the 15 NSW LHD intranets. The review reports counts, term frequencies, alignment observations, and geographic distribution percentages. The abstract does not provide detailed information on the READ approach steps, quality appraisal of documents, or specific examples of misalignment with PD_2014_030; such details likely appear in the full text. Likewise, the abstract does not specify temporal coverage (dates of documents searched) or whether publicly available non-intranet resources were included.
In conclusion, the review finds notable inconsistencies in terminology and variable document availability across regions of NSW. These discrepancies point to a need for clearer, uniform definitions and better alignment between state policy and local documentation to support clinicians involved in end-of-life planning and related clinical governance.
Keywords reported by the authors include clinical deterioration; comparative document review; critical care nursing; end-of-life planning; governance; in-hospital cardiac arrest; policy documents; quality and safety in healthcare; rapid response systems; and resuscitation planning.