Advance Care Planning in Older Adults With Multiple Chronic Conditions Undergoing High-Risk Surgery

Tang, Victoria; Dillon, Ellis C; Yan, Yang; Tai–Seale, Ming; Boscardin, John; Kata, Anna; Sudore, Rebecca L.

doi:10.1001/jamasurg.2018.4647

Cited by 33 publications

(37 citation statements)

References 6 publications

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“…This highlights a need for education and quality improvement, and holds health policy implications. 5 Despite patients and physicians recognizing the importance of ACP, patients with cancer frequently have no documented end-of-life plan. 6 Barriers to the documentation of ACP frequently include an absence of training and lack of sufficient time.…”

Section: Discussionmentioning

confidence: 99%

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Advance care planning in adults with oral cancer: Multi‐institutional cross‐sectional study

Forner

Lee

Grewal

et al. 2021

Laryngoscope Investig Oto

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Purpose: Patients undergoing head and neck surgery are often elderly and frail with significant comorbidities. Discussion and documentation of what patients would desire for end-of-life care and decision-making is, therefore, essential for delivering patient-centered care.Materials and Methods: This was a retrospective, cross-sectional study of patients undergoing surgery for head and neck cancer at two large, academic, tertiary care centers in Canada. Advance care planning was defined as any documentation of advance directives, resuscitation orders, or end-of-life care preferences.Results: Among 301 patients, advance care planning was documented for 31 (10.3%). Patients with locally advanced disease (T3+) were twice as likely to have

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Section: Discussionmentioning

confidence: 99%

“…This highlights a need for education and quality improvement, and holds health policy implications. 5 …”

Section: Discussionmentioning

confidence: 99%

Advance care planning in adults with oral cancer: Multi‐institutional cross‐sectional study

Forner

Lee

Grewal

et al. 2021

Laryngoscope Investig Oto

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“…A research letter in JAMA Surgery explored a population of elderly patients with chronic comorbidities and found that only 30% of those who died within a year of surgery had any ACP documented. 8 Likewise, a review of ACP and end-of-life discussions in the perioperative period found that, although providers seemed to view these discussions positively, limited educational and training content was available. 9 Despite the limited evidence to this point regarding perioperative ACP, there are a few populations where this approach has been studied.…”

Section: Discussionmentioning

confidence: 99%

Chronic and Sudden Serious Illness, COVID-19, and Decision-Making Capacity: Integrating Advance Care Planning Into the Preoperative Checklist for Elective Surgery

Rivet¹,

Blades

Hutson

et al. 2020

The American Surgeon™

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Advance Care Planning (ACP) includes anticipating future medical decisions and designating a medical decision maker in the event of losing the capacity to make one’s own medical decisions. Many advantages can be seen to doing ACP before a crisis as well as revisiting these discussions over time as circumstances change. This case presentation is of a 74-year-old woman with multiple medical problems who had ACP discussions in the context of proposed surgery for colon cancer. These conversations highlight the elements of high-quality ACP and the importance of learning what patients mean when they employ phrases commonly referenced in these conversations. The planned surgery was delayed by the COVID-19 pandemic but the discussions helped to guide decision-making when the patient became critically ill with COVID-19.

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“…"Data on the receipt of the aforementioned 6 LSTs [cardiopulmonary resuscitation, intensive care unit care, chest compression, intubation with mechanical ventilation, nasogastric tube feeding, and intravenous nutrition] in patients' last month of life were retrieved from medical records and supplemented by caregivers' reports during bereavement follow-ups" [16]. This example specifies that the review was of care received in the last month of life, but studies relying on retrospective chart review did not consistently specify the window of treatment time considered.…”

Section: Methodsmentioning

confidence: 99%

Advance care planning evaluation: a scoping review of best research practice

Gloeckler

Krones

Biller‐Andorno

2021

BMJ Support Palliat Care

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Various indicators have been used to evaluate advance care planning, including completion rates, type of care received, and satisfaction. Recent consensus suggests, though, that receiving care consistent with one’s goals is the primary outcome of advance care planning and assessment should capture this metric. Goal concordant care is challenging to measure, and there is little clarity about how best to do so. The aim of this scoping review is to explore what methods have been used to measure goal concordant care in the evaluation of advance care planning. PubMed, Embase, PsycINFO, CINAHL and Cochrane were searched in September 2020 to identify studies that aimed to track whether advance care planning affected the likelihood of patients receiving care that matched their preferred care. 135 original studies were included for review. Studies used retrospective chart review (36%, n=49), questionnaire (36%, n=48) and interview (31%, n=42), focusing on both patients and proxies. Studies considered both actual care received (55%, n=74) and hypothetical scenarios anticipating possible future care (49%, n=66); some studies did both. While the reviewed studies demonstrate the possibility of working towards a solid methodology, there were significant weaknesses. Notably, studies often lacked enough reporting clarity to be reproducible and, relatedly, key concepts, such as end-of-life or preferred care, were left undefined. The recommendations that follow from these findings inform future research approaches, supporting the development of a strong evidence base to guide advance care planning implementation in practice.

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Advance Care Planning in Older Adults With Multiple Chronic Conditions Undergoing High-Risk Surgery

Abstract: Conflict of Interest Disclosures: Dr Chu reported serving as the national proctor for novel surgical technique of trileaflet aortic valve neocuspidization using autologous pericardium (Ozaki procedure) for the Japanese Organization for

Cited by 33 publications

References 6 publications

Advance care planning in adults with oral cancer: Multi‐institutional cross‐sectional study

Advance care planning in adults with oral cancer: Multi‐institutional cross‐sectional study

Chronic and Sudden Serious Illness, COVID-19, and Decision-Making Capacity: Integrating Advance Care Planning Into the Preoperative Checklist for Elective Surgery

Advance care planning evaluation: a scoping review of best research practice

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