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Effect of a Disease‐Specific Advance Care Planning Intervention on End‐of‐Life Care
Author(s) -
Kirchhoff Karin T.,
Hammes Bernard J.,
Kehl Karen A.,
Briggs Linda A.,
Brown Roger L.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.03917.x
Subject(s) - medicine , advance care planning , facilitator , randomized controlled trial , end of life care , dialysis , cardiopulmonary resuscitation , end stage renal disease , intervention (counseling) , disease , intensive care medicine , medline , emergency medicine , resuscitation , nursing , palliative care , political science , law
Objectives To compare patient preferences for end‐of‐life care with care received at the end of life. Design A randomized controlled trial was conducted with individuals with congestive heart failure or end‐stage renal disease and their surrogates who were randomized to receive patient‐centered advance care planning (PC‐ACP) or usual care. Setting Two centers in Wisconsin with associated clinics and dialysis units. Participants Of the 313 individuals and their surrogates who completed entry data, 110 died. Intervention During PC‐ACP, the trained facilitator assessed individual and surrogate understanding of and experiences with the illness, provided information about disease‐specific treatment options and their benefits and burden, assisted in documentation of treatment preferences, and assisted the surrogates in understanding the patient's preferences and the surrogate's role. Measurements Preferences were documented and compared with care received at the end of life according to surrogate interviews or medical charts. Results Patients (74%) frequently continued to make their own decisions about care to the end. The experimental group had fewer (1/62) cases in which patients' wishes about cardiopulmonary resuscitation were not met than in the control group (6/48) but not significantly so. Significantly more experimental patients withdrew from dialysis than controls. Conclusion Patients and their surrogates were generally willing to discuss preferences with a trained facilitator. Most patients received the care they desired at end of life or altered their preferences to be in accord with the care they could receive. A larger sample with surrogate decision‐makers is needed to detect significant differences.