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Documentation of advance care planning for community-dwelling elders.
J Palliat Med. 2010 Jul; 13(7):861-7.JP

Abstract

BACKGROUND

Advance planning for end-of-life care has gained acceptance, but actual end-of-life care is often incongruent with patients' previously stated goals. We assessed the flow of advance care planning information from patients to medical records in a community sample of older adults to better understand why advance care planning is not more successful.

METHODS

Our study used structured interview and medical record data from community-dwelling older patients in two previous studies: Assessing Care of Vulnerable Elders (ACOVE)-1 (245 patients age > or = 65 years and screened for high risk of death/functional decline in 1998-1999) and ACOVE-2 (566 patients age > or = 75 who screened positive for falls/mobility disorders, incontinence, and/or dementia in 2002-2003). We compared interview data on patients' preferences, advance directives, and surrogate decision-makers with findings from the medical record.

RESULTS

In ACOVE-1, 38% of surveyed patients had thought about limiting the aggressiveness of medical care; 24% of surveyed patients stated that they had spoken to their doctor about this. The vast majority of patients (88%-93%) preferred to die rather than remain permanently in a coma, on a ventilator, or tube fed. Regardless of patients' specific preferences, 15%-22% of patients had preference information in their medical record. Among patients who reported that they had completed an advance directive and had given it to their health-care provider, 15% (ACOVE-1) and 47% (ACOVE-2) had advance directive information in the medical record. Among patients who had not completed an advance directive but had given surrogate decision-maker information to their provider, 0% (ACOVE-1) and 16% (ACOVE-2) had documentation of a surrogate decision-maker in the medical record.

CONCLUSIONS

Community-dwelling elders' preferences for end-of-life care are not consistent with documentation in their medical records. Electronic health records and standardized data collection for end-of-life care could begin to ameliorate this problem.

Authors+Show Affiliations

David Geffen School of Medicine at UCLA, Los Angeles, California, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

20618087

Citation

Yung, Victoria Y., et al. "Documentation of Advance Care Planning for Community-dwelling Elders." Journal of Palliative Medicine, vol. 13, no. 7, 2010, pp. 861-7.
Yung VY, Walling AM, Min L, et al. Documentation of advance care planning for community-dwelling elders. J Palliat Med. 2010;13(7):861-7.
Yung, V. Y., Walling, A. M., Min, L., Wenger, N. S., & Ganz, D. A. (2010). Documentation of advance care planning for community-dwelling elders. Journal of Palliative Medicine, 13(7), 861-7. https://doi.org/10.1089/jpm.2009.0341
Yung VY, et al. Documentation of Advance Care Planning for Community-dwelling Elders. J Palliat Med. 2010;13(7):861-7. PubMed PMID: 20618087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Documentation of advance care planning for community-dwelling elders. AU - Yung,Victoria Y, AU - Walling,Anne M, AU - Min,Lillian, AU - Wenger,Neil S, AU - Ganz,David A, PY - 2010/7/13/entrez PY - 2010/7/14/pubmed PY - 2010/12/14/medline SP - 861 EP - 7 JF - Journal of palliative medicine JO - J Palliat Med VL - 13 IS - 7 N2 - BACKGROUND: Advance planning for end-of-life care has gained acceptance, but actual end-of-life care is often incongruent with patients' previously stated goals. We assessed the flow of advance care planning information from patients to medical records in a community sample of older adults to better understand why advance care planning is not more successful. METHODS: Our study used structured interview and medical record data from community-dwelling older patients in two previous studies: Assessing Care of Vulnerable Elders (ACOVE)-1 (245 patients age > or = 65 years and screened for high risk of death/functional decline in 1998-1999) and ACOVE-2 (566 patients age > or = 75 who screened positive for falls/mobility disorders, incontinence, and/or dementia in 2002-2003). We compared interview data on patients' preferences, advance directives, and surrogate decision-makers with findings from the medical record. RESULTS: In ACOVE-1, 38% of surveyed patients had thought about limiting the aggressiveness of medical care; 24% of surveyed patients stated that they had spoken to their doctor about this. The vast majority of patients (88%-93%) preferred to die rather than remain permanently in a coma, on a ventilator, or tube fed. Regardless of patients' specific preferences, 15%-22% of patients had preference information in their medical record. Among patients who reported that they had completed an advance directive and had given it to their health-care provider, 15% (ACOVE-1) and 47% (ACOVE-2) had advance directive information in the medical record. Among patients who had not completed an advance directive but had given surrogate decision-maker information to their provider, 0% (ACOVE-1) and 16% (ACOVE-2) had documentation of a surrogate decision-maker in the medical record. CONCLUSIONS: Community-dwelling elders' preferences for end-of-life care are not consistent with documentation in their medical records. Electronic health records and standardized data collection for end-of-life care could begin to ameliorate this problem. SN - 1557-7740 UR - https://www.unboundmedicine.com/medline/citation/20618087/Documentation_of_advance_care_planning_for_community_dwelling_elders_ L2 - https://www.liebertpub.com/doi/10.1089/jpm.2009.0341?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -