Examining Age Inequalities in Operationalized Components of Advance Care Planning: Truncation of the ACP Process With Age

Prater, Laura; Wickizer, Thomas M.; Bose‐Brill, Seuli

doi:10.1016/j.jpainsymman.2018.12.338

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…Our study indicates that EHR-documented ACP is associated with reduced odds of admission in the last 30 days of life. Prior studies have shown that only 13% to 44% of terminally ill patients have documentation of ACP in the EHR 59 and that it is often inconsistent in location. 60 Consistency in documentation location and retrievability of pertinent information relevant to care coordination across settings of care continues to be a major concern among providers.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Advance Care Planning on End-of-Life Care: Do the Type and Timing Make a Difference for Patients With Advanced Cancer Referred to Hospice?

Prater

Wickizer

Bower

et al. 2019

Am J Hosp Palliat Care

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Purpose: This study aimed to determine the impact of advanced care planning (ACP) on potentially avoidable hospital admissions at the end of life (EOL) among a sample of hospice-referred patients with cancer, in order to present actionable considerations for the practicing clinician. Methods: This study was designed as a retrospective cohort using electronic health record data that assessed likelihood of hospital admissions in the last 30 days of life for 1185 patients with a primary diagnosis of cancer, referred to hospice between January 1, 2014, and December 31, 2015, at a large academic medical center. Inverse probability treatment weighting based on calculated propensity scores balanced measured covariates between those with and without ACP at baseline. Odds ratios (ORs) were calculated from estimated potential outcome means for the impact of ACP on admissions in the last 30 days of life. Results: A verified do-not-resuscitate (DNR) order prior to the last 30 days of life was associated with reduced odds of admission compared to those without a DNR (OR = 0.30; P < .001). An ACP note in the problem list prior to the last 30 days of life was associated with reduced odds of admission compared to those without an ACP note (OR = 0.71, P = .042), and further reduced odds if done 6 months prior to death (OR = 0.35, P < .001). Conclusions: This study shows that dedicated ACP documentation is associated with fewer admissions in the last 30 days of life for patients with advanced cancer referred to hospice. Improving ACP processes prior to hospice referral holds promise for reducing EOL admissions.

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Section: Discussionmentioning

confidence: 99%

The Impact of Advance Care Planning on End-of-Life Care: Do the Type and Timing Make a Difference for Patients With Advanced Cancer Referred to Hospice?

Prater

Wickizer

Bower

et al. 2019

Am J Hosp Palliat Care

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“…The reliability and validity of measurements is one of the challenges of ACP studies [ 8 ], but patient-reported outcomes and experiences are important measures in the process of ACP as a complex, relational, and subjective form of communication. Older age was associated with lower conversation frequency; both patient and HCP biases and preferences for communication may explain the variation seen [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Colorectal Cancer Patients’ Reported Frequency, Content, and Satisfaction with Advance Care Planning Discussions

Hussein,

Lim,

Manokaran

et al. 2024

Current Oncology

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(1) Background: This observational cohort study describes the frequency, content, and satisfaction of advance care planning (ACP) conversations with healthcare providers (HCPs), as reported by patients with advanced colorectal cancer. (2) Methods: The patients were recruited from two tertiary cancer centers in Alberta, Canada. Using the My Conversations survey with previously validated questions, the patients were asked about specific ACP elements discussed, with which HCPs these elements were discussed, their satisfaction with these conversations, and whether they had a goals of care designation (GCD) order. We surveyed and analyzed data from the following four time points: enrollment, months 1, 2, and 3. (3) Results: In total, 131 patients were recruited. At enrollment, 24% of patients reported discussing at least one ACP topic. From enrollment to month 3, patients reported a high frequency of discussions (80.2% discussed fears, 71.0% discussed prognosis, 54.2% discussed treatment preferences at least once); however, only 44.3% of patients reported discussing what is important to them in considering health care preferences. Patients reported having ACP conversations most often with their oncologists (84.7%) and cancer clinic nurses (61.8%). Patients reported a high level of satisfaction with their ACP conversations, with over 80% of patients reported feeling heard and understood. From enrollment to month 3, there was an increase in the number of patients with a GCD order from 53% to 74%. (4) Conclusions: Patients reported more frequent conversations compared to the literature and clinical documentation. While the satisfaction with these conversations is high, there is room for quality improvement, particularly in eliciting patients’ personal goals for their treatment.

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“…5,11,13 Despite a favorable evidence-base strongly indicating that ACP and related elements improve patient, caregiver and system-level outcomes, only between 13-44% of patients with advanced illnesses, including cancer, engage in ACP. [14][15][16] Health system standardization of ACP procedures can overcome gaps in ACP delivery [17][18][19] ; however, many published processes for ACP implementation at the level of the health system have demonstrated limited sustainability and limited ability for large-scale evaluation. 20 Billable ACP services, made possible by the Centers for Medicare and Medicaid Services (CMS) decision to create reimbursement codes for ACP conversations in 2016, represents an emerging mechanism for standardized ACP delivery.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Examining the Association of Billed Advance Care Planning With End-of-Life Hospital Admissions Among Advanced Cancer Patients in Hospice

Prater

O'Rourke

Schnell

et al. 2021

Am J Hosp Palliat Care

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Background: Advance care planning (ACP), or the consideration and communication of care preferences for the end-of-life (EOL), is a critical process for improving quality of care for patients with advanced cancer. The incorporation of billed service codes for ACP allows for new inquiries on the association between systematic ACP and improved EOL outcomes. Objective: Using the IBM MarketScan® Database, we conducted a retrospective medical claims analysis for patients with an advanced cancer diagnosis and referral to hospice between January 2016 and December 2017. We evaluated the association between billed ACP services and EOL hospital admissions in the final 30 days of life. Design: This is a cross-sectional retrospective cohort study. Participants: A total of 3,705 patients met the study criteria. Main Measures: ACP was measured via the presence of a billed ACP encounter (codes 99497 and 99498) prior to the last 30 days of life; hospital admissions included a dichotomous indicator for inpatient admission in the final 30 days of life. Key Results: Controlling for key covariates, patients who received billed ACP were less likely to experience inpatient hospital admissions in the final 30 days of life compared to those not receiving billed ACP (OR: 0.34; p < 0.001). Conclusion: The receipt of a billed ACP encounter is associated with reduced EOL hospital admissions in a population of patients with advanced cancer on hospice care. Strategies for consistent, anticipatory delivery of billable ACP services prior to hospice referral may prevent potentially undesired late-life hospital admissions.

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Examining Age Inequalities in Operationalized Components of Advance Care Planning: Truncation of the ACP Process With Age

Cited by 4 publications

References 31 publications

The Impact of Advance Care Planning on End-of-Life Care: Do the Type and Timing Make a Difference for Patients With Advanced Cancer Referred to Hospice?

The Impact of Advance Care Planning on End-of-Life Care: Do the Type and Timing Make a Difference for Patients With Advanced Cancer Referred to Hospice?

Colorectal Cancer Patients’ Reported Frequency, Content, and Satisfaction with Advance Care Planning Discussions

Examining the Association of Billed Advance Care Planning With End-of-Life Hospital Admissions Among Advanced Cancer Patients in Hospice

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