Prognostic Indices for Advance Care Planning in Primary Care: A Scoping Review

Abstract

Background: Patient identification is an important step for advance care planning (ACP) discussions. Objectives: We conducted a scoping review to identify prognostic indices potentially useful for initiating ACP. Methods: We included studies that developed and/or validated a multivariable prognostic index for all-cause mortality between 6 months and 5 years in community-dwelling adults. PubMed was searched in October 2018 for articles meeting our search criteria. If a systematic review was identified from the search, we checked for additional eligible articles in its references. We abstracted data on population studied, discrimination, calibration, where to find the index, and variables included. Each index was further assessed for clinical usability. Results: We identified 18 articles with a total of 17 unique prognostic indices after screening 9154 titles. The majority of indices (88%) had c-statistics greater than or equal to 0.70. Only 1 index was externally validated. Ten indices, 8 developed in the United States and 2 in the United Kingdom, were considered clinically usable. Conclusion: Of the 17 unique prognostic indices, 10 may be useful for implementation in the primary care setting to identify patients who may benefit from ACP discussions. An index classified as "clinically usable" may not be easy to use because of a large number of variables that are not routinely collected and the need to program the index into the electronic medical record.

Views of Cancer Patients, Families, and Providers on Initiating and Engaging in Advance Care Planning: A Qualitative Study

“…When they do initiate these conversations, participants described doing so based on their own clinical acumen. Similar experiences have been described in other studies (30,31). Kim et al (2020) showed that the physician's interpretation of a patient prognosis was a key factor in initiating ACP discussions in primary care.…”

Views of advanced cancer patients, families, and oncologists on initiating and engaging in advance care planning: a qualitative study

“…Similar experiences have been described in other studies [36,37]. Kim et al showed that the physician's interpretation of a patient prognosis was a key factor in initiating ACP discussions in primary care [36]. Despite this, a Canadian study of ACP and EOL plans in elderly individuals, who were at a high risk of death in 6 months, described that although > 75% of patients had thought of EOL care, only 47% had completed ACP and less than 30% had discussed their wishes with their family physician.…”

“…When they do initiate these conversations, participants described doing so based on their own clinical acumen. Similar experiences have been described in other studies [36,37]. Kim et al showed that the physician's interpretation of a patient prognosis was a key factor in initiating ACP discussions in primary care [36].…”

Views of advanced cancer patients, families, and oncologists on initiating and engaging in advance care planning: a qualitative study

“…When they do initiate these conversations, participants described doing so based on their own clinical acumen. Similar experiences have been described in other studies (38,39). Kim et al (2020) showed that the physician's interpretation of a patient prognosis was a key factor in initiating ACP discussions in primary care.…”

“…Similar experiences have been described in other studies (38,39). Kim et al (2020) showed that the physician's interpretation of a patient prognosis was a key factor in initiating ACP discussions in primary care. Despite this, a Canadian study of ACP and EOL plans in elderly individuals, who were at a high risk of death in 6 months, described that although >75% of patients had thought of EOL care, only 47% had completed ACP and less than 30% had discussed their wishes with their family physician.…”