Documentation of Advance Care Planning for Community-Dwelling Elders

David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Journal of palliative medicine (Impact Factor: 1.91). 07/2010; 13(7):861-7. DOI: 10.1089/jpm.2009.0341
Source: PubMed


Advance planning for end-of-life care has gained acceptance, but actual end-of-life care is often incongruent with patients' previously stated goals. We assessed the flow of advance care planning information from patients to medical records in a community sample of older adults to better understand why advance care planning is not more successful.
Our study used structured interview and medical record data from community-dwelling older patients in two previous studies: Assessing Care of Vulnerable Elders (ACOVE)-1 (245 patients age > or = 65 years and screened for high risk of death/functional decline in 1998-1999) and ACOVE-2 (566 patients age > or = 75 who screened positive for falls/mobility disorders, incontinence, and/or dementia in 2002-2003). We compared interview data on patients' preferences, advance directives, and surrogate decision-makers with findings from the medical record.
In ACOVE-1, 38% of surveyed patients had thought about limiting the aggressiveness of medical care; 24% of surveyed patients stated that they had spoken to their doctor about this. The vast majority of patients (88%-93%) preferred to die rather than remain permanently in a coma, on a ventilator, or tube fed. Regardless of patients' specific preferences, 15%-22% of patients had preference information in their medical record. Among patients who reported that they had completed an advance directive and had given it to their health-care provider, 15% (ACOVE-1) and 47% (ACOVE-2) had advance directive information in the medical record. Among patients who had not completed an advance directive but had given surrogate decision-maker information to their provider, 0% (ACOVE-1) and 16% (ACOVE-2) had documentation of a surrogate decision-maker in the medical record.
Community-dwelling elders' preferences for end-of-life care are not consistent with documentation in their medical records. Electronic health records and standardized data collection for end-of-life care could begin to ameliorate this problem.

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Available from: Lillian Chiang Min, Feb 27, 2014
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    • "Efforts to appropriately match medical care with patients’ goals for care focus on advance care planning—that is, discussing a patient’s clinical condition and prognosis and mapping out future care according to a patient’s preferences—and ensuring that such plans transition with patients across care venues to guide care. Despite broad endorsement of advance care planning,1 continuity of preferences across venues2,3 and over time4 has been poor, resulting in the potential for patients to receive treatments that they would not have desired. Because aggressive treatment is the default, misunderstood preferences translate into treatments not aimed at patient goals rather than symptom management.5 "
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