Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care

Yadav, Kuldeep N.; Gabler, Nicole B.; Cooney, Elizabeth; Kent, Saida; Kim, Jennifer; Herbst, Nicole; Mante, Adjoa; Halpern, Scott D.; Courtright, Katherine R.

doi:10.1377/hlthaff.2017.0175

Cited by 483 publications

(366 citation statements)

References 41 publications

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“…The VA is an exceptional national model of ACP documentation in that it includes a centralized posting section in the EHR for ACP, is dedicated to ACP initiatives, 13–17,25,29 and half of chronically ill, older Veterans in this study had documented ACP wishes, well above national norms. 30 However, given that many non-VA health systems do not have similar established EHRs and dedicated ACP programs, these study findings point to a likely widely generalizable quality improvement gap for patient safety in ACP. For example, 50% of patients with a completed form or physician order in this study did not have an accompanying documented ACP discussion about that form/order in the EHR.…”

Section: Discussionmentioning

confidence: 76%

Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety

Walker

McMahan²,

Barnes

et al. 2018

Journal of Pain and Symptom Management

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Importance Documenting patients’ advance care planning wishes is essential to providing value-aligned care, as is having this documentation readily accessible. Little is known about advance care planning documentation practices in the electronic health record. Objective Describe advance care planning documentation practices and the accessibility of documented discussions in the electronic health record. Design Cross-sectional study between 2013-2015. Setting Primary care clinics at the San Francisco Veterans Affairs Medical Center. Participants Veterans ≥60 years of age with ≥2 chronic/serious health conditions, ≥2 primary care visits, and ≥2 additional clinic/hospital/emergency room visits in the prior year who were participating in an advance care planning trial. Exposure Documentation of advance care planning in the electronic health record. Main Measures Advance care planning documentation, including all prior legal forms/orders and documented discussions within the prior five years. For discussions, the author’s discipline and documentation location in the electronic health record were determined. Discussions were defined as “accessible” if documented in a designated electronic posting location or “not easily accessible” if recorded as free-text in progress notes. Percentages and means were used to describe these measures. Key Results The mean age of 414 participants was 71 years (SD ±8), 9% were women, 43% were non-white, and 51% had documented advance care planning including 149 (36%) with forms/orders and 138 (33%) with discussions. Seventy-four participants (50%) with forms/orders did not have accompanying documented discussions. Most (55%) discussions were not easily accessible. Twenty-seven participants had a subsequent discussion documenting changes in treatment preferences from a prior form/order; however, 70% of these discussions were not easily accessible. Conclusions and Relevance Half of chronically ill, older participants had documented advance care planning wishes, including one third with documented discussions. However, half of the patients with completed legal forms/orders had no accompanying explanatory discussions. The majority of documented discussions were not easily accessible in the electronic health record, including 70% of those documenting a change in treatment preferences. Ensuring that patients’ preferences are documented and easily accessible is an important patient safety and quality improvement target to ensure patients’ wishes are honored.

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Section: Discussionmentioning

confidence: 76%

Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety

Walker

McMahan²,

Barnes

et al. 2018

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

show abstract

“…Although international comparisons should be undertaken cautiously given differences in populations and health systems as well as legal frameworks and terminology, community prevalence is estimated to range from 18% to 37% in the United States 21,22 and 3% to 19% in Europe. 23,24 These findings about prevalence differ from those of the earlier national community prevalence study.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of advance care directives in the community: a telephone survey of three Australian States

White

Willmott

Tilse

et al. 2019

Internal Medicine Journal

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Background The community prevalence of advance care directives (ACD) is low despite known benefits of advance care planning for patients, families and health professionals. Aim To determine the community prevalence of instructional and appointing ACD in New South Wales, Victoria and Queensland and factors associated with completion of these documents. Methods A telephone survey of adults living in New South Wales, Victoria and Queensland (n = 1175) about completion of instructional ACD (making their own decisions about future healthcare) and appointing ACD (appointing another to decide). Quota sampling occurred based on population size by state, gender and age, with oversampling in smaller jurisdictions (Victoria and Queensland). Results Overall response rate was 33%. Six per cent of respondents reported completing an instructional ACD while 12% reported completing an appointing ACD. Female gender, higher educational level, personal experience of a major health scare and being widowed were significant predictors of completing an instructional ACD. Older age, higher educational level and being widowed were significant predictors of completing an appointing ACD. Conclusions Despite long‐standing efforts to increase advance care planning, community prevalence of ACD remains low, particularly for instructional ACD. This study found some different predictors for instructional ACD compared with appointing ACD, and also a potential role for experiential factors in triggering uptake. These findings suggest supplementing general community awareness campaigns with more nuanced and targeted efforts to improve ACD completion.

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“…Other strong predictors of ACP discussion and documentation were health/healthcare‐related factors. Although having a chronic progressive illness and reports of recent healthcare utilization had very modest associations with ACP documentation only in our participants (consistent with a large systematic review in 2017 on the prevalence of advanced directives), ill health and greater healthcare utilization were among the strongest predictors of documentation accompanied by recent discussion, perhaps pointing to the tendency to delay discussions about ACP with healthcare providers . One finding of note was that having a physician exam for only screening purposes was associated with a 40% greater prevalence of documentation and discussion, possibly reflecting the role of the primary care physician in facilitating ACP .…”

Section: Discussionmentioning

confidence: 99%

Predictors of Advance Care Planning in Older Women: The Nurses’ Health Study

Kang

Bynum

Zhang

et al. 2018

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Relatively little is known regarding predictors of advance care planning (ACP) in former nurses. We aimed to evaluate potential predictors of ACP documentation and discussion. DESIGN Cross‐sectional study, 2012‐2014. SETTING Nurses’ Health Study. PARTICIPANTS A total of 60,917 community‐dwelling female nurses aged 66 to 93 years living across the United States. MEASUREMENTS Based on self‐reports, participants were categorized as having (1) only ACP documentation, (2) ACP documentation and a recent ACP discussion with a healthcare provider, or (3) neither. Multivariable log‐binomial models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of the two separate ACP categories vs those with neither. We evaluated various demographic, health, and social factors. RESULTS The large majority (84%) reported ACP documentation; 35% reported a recent ACP discussion. Demographic factors such as age and race were associated with both ACP categories. In multivariable analyses, race was most strongly associated: compared with whites, African Americans were 27% less likely (PR = 0.73; 95% CI = 0.69‐0.78) to report ACP documentation alone and 41% (PR = 0.59; 95% CI = 0.54‐0.66) less likely to report documentation with discussion. Additionally, health/healthcare‐related characteristics were more strongly associated with ACP documentation plus discussion. Women with functional limitations (PR = 1.15; 95% CI = 1.10‐1.20), women who were recently hospitalized (PR: 1.10; 95% CI = 1.08‐1.12) or women who had seen a physician for health symptoms (PR = 1.43; 95% CI = 1.35‐1.52) or screening (PR = 1.40; 95% CI = 1.32‐1.49) were more likely to report having both ACP documentation and discussion. Social factors showed limited relationships with ACP documentation only; for documentation plus discussion, being widowed and living alone was associated with higher prevalence (PR = 1.21; 95% CI = 1.19‐1.24) and having little emotional support was associated with lower prevalence (PR = 0.84; 95% CI = 0.81‐0.86). CONCLUSIONS Among older nurses, most of whom reported having documented ACP, 35% reported recent patient‐clinician ACP discussions, indicating a major participatory gap in an element critical to ACP effectiveness. Even in nurses, African Americans reported less ACP documentation or discussion. J Am Geriatr Soc 67:292–301, 2019.

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Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care

Cited by 483 publications

References 41 publications

Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety

Advance Care Planning Documentation Practices and Accessibility in the Electronic Health Record: Implications for Patient Safety

Prevalence of advance care directives in the community: a telephone survey of three Australian States

Predictors of Advance Care Planning in Older Women: The Nurses’ Health Study

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