Effect of a Disease-Specific Advance Care Planning Intervention on End-of-Life Care.
Kirchhoff, Karin T. PhD, RN 1; Hammes, Bernard J. PhD 2; Kehl, Karen A. PhD, RN 1,3; Briggs, Linda A. MA, MS, RN 2; Brown, Roger L. PhD 1
Journal of the American Geriatrics Society.
60(5):946-950, May 2012.
(Format: HTML, PDF)
OBJECTIVES: To compare patient preferences for end-of-life care with care received at the end of life.
DESIGN: A randomized controlled trial was conducted with individuals with congestive heart failure or end-stage renal disease and their surrogates who were randomized to receive patient-centered advance care planning (PC-ACP) or usual care.
SETTING: Two centers in Wisconsin with associated clinics and dialysis units.
PARTICIPANTS: Of the 313 individuals and their surrogates who completed entry data, 110 died.
INTERVENTION: During PC-ACP, the trained facilitator assessed individual and surrogate understanding of and experiences with the illness, provided information about disease-specific treatment options and their benefits and burden, assisted in documentation of treatment preferences, and assisted the surrogates in understanding the patient's preferences and the surrogate's role.
MEASUREMENTS: Preferences were documented and compared with care received at the end of life according to surrogate interviews or medical charts.
RESULTS: Patients (74%) frequently continued to make their own decisions about care to the end. The experimental group had fewer (1/62) cases in which patients' wishes about cardiopulmonary resuscitation were not met than in the control group (6/48) but not significantly so. Significantly more experimental patients withdrew from dialysis than controls.
CONCLUSION: Patients and their surrogates were generally willing to discuss preferences with a trained facilitator. Most patients received the care they desired at end of life or altered their preferences to be in accord with the care they could receive. A larger sample with surrogate decision-makers is needed to detect significant differences.
(C) 2012 by the American Geriatrics Society