Tags

Type your tag names separated by a space and hit enter

Single-centre cross-sectional analysis of advance care planning among elderly inpatients.
Intern Med J. 2014 Oct; 44(10):967-74.IM

Abstract

BACKGROUND

Advance care planning (ACP) has been shown to provide beneficial outcomes for elderly patients; however, it may not be commonly implemented.

AIMS

To assess prevalence of advance care directives (ACD) and documented medical orders about end-of-life care for elderly inpatients; to explore the feasibility of an ACP screening interview.

METHODS

A single-centre cross-sectional analysis of 100 consecutive patients aged ≥80 years admitted for ≥48 h to a tertiary referral hospital, conducted between 16 and 18 January 2013. Medical records were reviewed for presence of (i) an ACD, (ii) resuscitation/end-of-life care intervention orders (REOL) and (iii) documented substitute decision-maker (SDM). If patients were able and willing to participate they completed an ACP screening interview exploring (i) their views on ACP and (ii) if an ACD was previously documented.

RESULTS

In 100 medical records, there were: zero ACD, 17 REOL and 8 with clear documentation of patients' preferred SDM. Out of 100 patients, 33 completed the interview: 32 (97%) were able to identify their preferred SDM, in 9 (27%) the nominated SDM was different from their 'next of kin'. Out of 33, 7 (21%) reported having an enduring guardian, 4/33 (12%) an ACD. Out of 29, 23 (79%) interviewees without an ACD were interested in discussing ACP further. Out of 30, 8 (27%) interviewees without REOL said that they would not wish to have aggressive life-prolonging measures. No patients reported discomfort with the screening interview.

CONCLUSIONS

ACD and correct documentation of SDM were uncommon in the medical records in this sample of elderly inpatients. The ACP screening interview appears feasible and acceptable and may be a useful tool for identifying patients' preferred SDM and willingness to discuss ACP further.

Authors+Show Affiliations

Department of Palliative Care, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Aged Care, Royal North Shore Hospital, Sydney, New South Wales, Australia; Department of Aged Care, Blacktown District Hospital, Sydney, New South Wales, Australia; HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Sydney, New South Wales, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25109312

Citation

Cheang, F, et al. "Single-centre Cross-sectional Analysis of Advance Care Planning Among Elderly Inpatients." Internal Medicine Journal, vol. 44, no. 10, 2014, pp. 967-74.
Cheang F, Finnegan T, Stewart C, et al. Single-centre cross-sectional analysis of advance care planning among elderly inpatients. Intern Med J. 2014;44(10):967-74.
Cheang, F., Finnegan, T., Stewart, C., Hession, A., & Clayton, J. M. (2014). Single-centre cross-sectional analysis of advance care planning among elderly inpatients. Internal Medicine Journal, 44(10), 967-74. https://doi.org/10.1111/imj.12550
Cheang F, et al. Single-centre Cross-sectional Analysis of Advance Care Planning Among Elderly Inpatients. Intern Med J. 2014;44(10):967-74. PubMed PMID: 25109312.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Single-centre cross-sectional analysis of advance care planning among elderly inpatients. AU - Cheang,F, AU - Finnegan,T, AU - Stewart,C, AU - Hession,A, AU - Clayton,J M, PY - 2014/04/02/received PY - 2014/08/04/accepted PY - 2014/8/12/entrez PY - 2014/8/12/pubmed PY - 2015/7/15/medline KW - advance care planning KW - advance directives KW - aged 80 and over KW - decision-making KW - terminal care SP - 967 EP - 74 JF - Internal medicine journal JO - Intern Med J VL - 44 IS - 10 N2 - BACKGROUND: Advance care planning (ACP) has been shown to provide beneficial outcomes for elderly patients; however, it may not be commonly implemented. AIMS: To assess prevalence of advance care directives (ACD) and documented medical orders about end-of-life care for elderly inpatients; to explore the feasibility of an ACP screening interview. METHODS: A single-centre cross-sectional analysis of 100 consecutive patients aged ≥80 years admitted for ≥48 h to a tertiary referral hospital, conducted between 16 and 18 January 2013. Medical records were reviewed for presence of (i) an ACD, (ii) resuscitation/end-of-life care intervention orders (REOL) and (iii) documented substitute decision-maker (SDM). If patients were able and willing to participate they completed an ACP screening interview exploring (i) their views on ACP and (ii) if an ACD was previously documented. RESULTS: In 100 medical records, there were: zero ACD, 17 REOL and 8 with clear documentation of patients' preferred SDM. Out of 100 patients, 33 completed the interview: 32 (97%) were able to identify their preferred SDM, in 9 (27%) the nominated SDM was different from their 'next of kin'. Out of 33, 7 (21%) reported having an enduring guardian, 4/33 (12%) an ACD. Out of 29, 23 (79%) interviewees without an ACD were interested in discussing ACP further. Out of 30, 8 (27%) interviewees without REOL said that they would not wish to have aggressive life-prolonging measures. No patients reported discomfort with the screening interview. CONCLUSIONS: ACD and correct documentation of SDM were uncommon in the medical records in this sample of elderly inpatients. The ACP screening interview appears feasible and acceptable and may be a useful tool for identifying patients' preferred SDM and willingness to discuss ACP further. SN - 1445-5994 UR - https://www.unboundmedicine.com/medline/citation/25109312/Single_centre_cross_sectional_analysis_of_advance_care_planning_among_elderly_inpatients_ L2 - https://doi.org/10.1111/imj.12550 DB - PRIME DP - Unbound Medicine ER -