Early intervention in planning end-of-life care with ambulatory geriatric patients: results of a pilot trial
Department of Family Medicine and Community Health; Department of Surgery; Department of Medicine, Division of Preventive and Behavorial Medicine; Clinical and Population Health Research Program
*Advance Care Planning; Advance Directives; Aged; Aged, 80 and over; *Ambulatory Care; Attitude to Health; Decision Making; Feasibility Studies; Female; Follow-Up Studies; Humans; Intervention Studies; Male; *Patient Care Planning; Patient Education as Topic; Pilot Projects; Prospective Studies; Quality of Life; *Terminal Care; *Terminally Ill; Time Factors; Treatment Outcome
Behavior and Behavior Mechanisms | Community Health and Preventive Medicine | Geriatrics
BACKGROUND: A large discrepancy exists between the wishes of dying patients and their actual end-of-life care. However, retrospective clinical experience suggests that early advance care planning (ACP) can markedly reduce this discrepancy. This article describes a randomized trial to evaluate the short-term clinical utility of early ACP. We also assessed the feasibility of performing a larger prospective study to document long-term outcomes.
METHODS: Ambulatory geriatric patients (N = 61) were randomized to either a control group, which received only a Massachusetts Health Care Proxy form to complete, or an intervention group, in which each patient and health care agent discussed ACP with a trained nurse facilitator. The benefits and burdens of life-sustaining treatments were discussed, and patient goals and preferences for these treatments were documented.
RESULTS: Two-month follow-up revealed that the intervention achieved higher congruence between agents and patients in their understanding of patients' end-of-life care preferences, with 76% (19/25) in complete agreement vs 55% (12/22) of the controls (effect size [ES] = -0.43). There was also a greater increase in patient knowledge about ACP in the intervention group (ES = 0.22). Intervention patients became less willing to undergo life-sustaining treatments for a new serious medical problem (ES = -0.25), more willing to undergo such treatments for an incurable progressive disease (ES = 0.24), and less willing to tolerate poor health states (ES = -0.78). Practical insights were gained about how to conduct a larger study more effectively.
CONCLUSION: A facilitated discussion about end-of-life care between patients and their health care agents helps define and document the patient's wishes for both patient and agent.
Rights and Permissions
Citation: Arch Intern Med. 2002 Jul 22;162(14):1611-8.
Schwartz, Carolyn E.; Wheeler, H. Brownell; Hammes, Bernard; Basque, Noreen; Edmunds, Jean; Reed, George W.; Ma, Yunsheng; Li, Lynn; Tabloski, Patricia; and Yanko, Julianne, "Early intervention in planning end-of-life care with ambulatory geriatric patients: results of a pilot trial" (2002). Preventive and Behavioral Medicine Publications and Presentations. 38.