Open AccessFeasibility of a Brief Intervention to Facilitate Advance Care Planning Conversations for Patients with Life-Limiting Illness in the Emergency Department
Author(s) -
Sarah E Pajka,
Mohammad Adrian Hasdianda,
Naomi George,
Rebecca L. Sudore,
Mara A. Schonberg,
Edward Bernstein,
James A. Tulsky,
Susan D. Block,
Kei Ouchi
Publication year - 2021
Publication title -
journal of palliative medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.986
H-Index - 90
eISSN - 1096-6218
pISSN - 1557-7740
DOI - 10.1089/jpm.2020.0067
Subject(s) - advance care planning , medicine , emergency department , psychological intervention , intervention (counseling) , documentation , proxy (statistics) , palliative care , medical record , family medicine , emergency medicine , nursing , machine learning , computer science , programming language
Background: Advance care planning (ACP) conversations are an important intervention to provide care consistent with patient goals near the end of life. The emergency department (ED) could serve as an important time and location for these conversations. Objectives: To determine the feasibility of an ED-based, brief negotiated interview (BNI) to stimulate ACP conversations among seriously ill older adults. Methods: We conducted a pre/postintervention study in the ED of an urban, tertiary care, academic medical center. From November 2017 to May 2019, we prospectively enrolled adults ≥65 years of age with serious illness. Trained clinicians conducted the intervention. We measured patients' ACP engagement at baseline and follow-up (3 ± 1 weeks) and reviewed electronic medical record documentation of ACP (e.g., medical order for life-sustaining treatment [MOLST]). Results: We enrolled 51 patients (mean age = 71; SD 12), 41% were female, and 51% of patients had metastatic cancer. Median duration of the intervention was 11.8 minutes; few (6%) of the interventions were interrupted. We completed follow-up for 61% of participants. Patients' self-reported ACP engagement increased from 3.0 to 3.7 out of 5 after the intervention ( p < 0.01). Electronic documentation of health care proxy forms increased (75%-94%, n = 48) as did MOLST (0%-19%, n = 48) during the six months after the ED visit. Conclusion: A novel, ED-based, BNI intervention to stimulate ACP conversations for seriously ill older adults is feasible and may improve ACP engagement and documentation.