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Are older and seriously ill inpatients planning ahead for future medical care?
BMC Geriatr. 2019 08 05; 19(1):212.BG

Abstract

BACKGROUND

Despite the perceived ethical, personal and health service benefits of advance care planning (ACP), the extent to which older and seriously ill Australian inpatients have considered future health decisions remains uncertain. This study aimed to determine in a sample of older and seriously ill inpatients, the proportion who had: 1) engaged in four advance care planning (ACP) activities; 2) not engaged in ACP activities but wanted to; and 3) reasons why they had not engaged.

METHODS

Cross-sectional face-to-face standardised interview survey with inpatients in a tertiary referral centre who were either: aged 80+ years; aged 55+ years with progressive chronic disease(s); or judged by treating clinicians as having a life expectancy of less than 12 months. Patients indicated whether they had engaged in four ACP activities: (1) appointed medical substitute-decision-maker(s), (2) recorded end-of-life wishes in an advance directive or care plan; and talked about their end-of-life wishes with their: (3) support persons and/or (4) doctors. Patients who had not engaged in activities were asked whether they wished this to occur and reasons why.

RESULTS

One hundred eighty-six inpatients consented to the study (80% of approached). Of these, 9% (n = 16) had engaged in four ACP activities; 27% (n = 50) had not engaged in any. Half (n = 94, 52%) had appointed a medical substitute-decision-maker, 27% (n = 50) had recorded wishes in an advance directive or care plan, 51% (n = 90) had talked about their end-of-life wishes with support persons and 27% (n = 48) had talked with their doctor. Patients who wanted to, but had not, engaged in the four ACP activities were unaware they could record wishes or appoint decision-makers, or indicated providers had not initiated conversations.

CONCLUSION

Relatively few inpatients had engaged in all four ACP activities. More inpatients had discussed end of life issues with family and appointed substitute decision makers, than completed written documents or talked with doctors. Community education and a more active role for community and hospital-based providers in supporting patients and families to collaboratively resolve end-of-life decisions may increase the probability wishes are known and followed.

Authors+Show Affiliations

Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia. amy.waller@newcastle.edu.au. Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia. amy.waller@newcastle.edu.au.Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia. Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW, 2305, Australia. School of Medicine and Public Health (Medical Education and Professional Development), University of Newcastle, Callaghan, NSW, 2308, Australia.Clinical Research Design and Statistics Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31382893

Citation

Waller, Amy, et al. "Are Older and Seriously Ill Inpatients Planning Ahead for Future Medical Care?" BMC Geriatrics, vol. 19, no. 1, 2019, p. 212.
Waller A, Sanson-Fisher R, Nair BRK, et al. Are older and seriously ill inpatients planning ahead for future medical care? BMC Geriatr. 2019;19(1):212.
Waller, A., Sanson-Fisher, R., Nair, B. R. K., & Evans, T. (2019). Are older and seriously ill inpatients planning ahead for future medical care? BMC Geriatrics, 19(1), 212. https://doi.org/10.1186/s12877-019-1211-2
Waller A, et al. Are Older and Seriously Ill Inpatients Planning Ahead for Future Medical Care. BMC Geriatr. 2019 08 5;19(1):212. PubMed PMID: 31382893.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are older and seriously ill inpatients planning ahead for future medical care? AU - Waller,Amy, AU - Sanson-Fisher,Rob, AU - Nair,Balakrishnan R Kichu, AU - Evans,Tiffany, Y1 - 2019/08/05/ PY - 2018/11/16/received PY - 2019/07/11/accepted PY - 2019/8/7/entrez PY - 2019/8/7/pubmed PY - 2020/4/28/medline KW - Acute care KW - Advance care planning KW - End-of-life SP - 212 EP - 212 JF - BMC geriatrics JO - BMC Geriatr VL - 19 IS - 1 N2 - BACKGROUND: Despite the perceived ethical, personal and health service benefits of advance care planning (ACP), the extent to which older and seriously ill Australian inpatients have considered future health decisions remains uncertain. This study aimed to determine in a sample of older and seriously ill inpatients, the proportion who had: 1) engaged in four advance care planning (ACP) activities; 2) not engaged in ACP activities but wanted to; and 3) reasons why they had not engaged. METHODS: Cross-sectional face-to-face standardised interview survey with inpatients in a tertiary referral centre who were either: aged 80+ years; aged 55+ years with progressive chronic disease(s); or judged by treating clinicians as having a life expectancy of less than 12 months. Patients indicated whether they had engaged in four ACP activities: (1) appointed medical substitute-decision-maker(s), (2) recorded end-of-life wishes in an advance directive or care plan; and talked about their end-of-life wishes with their: (3) support persons and/or (4) doctors. Patients who had not engaged in activities were asked whether they wished this to occur and reasons why. RESULTS: One hundred eighty-six inpatients consented to the study (80% of approached). Of these, 9% (n = 16) had engaged in four ACP activities; 27% (n = 50) had not engaged in any. Half (n = 94, 52%) had appointed a medical substitute-decision-maker, 27% (n = 50) had recorded wishes in an advance directive or care plan, 51% (n = 90) had talked about their end-of-life wishes with support persons and 27% (n = 48) had talked with their doctor. Patients who wanted to, but had not, engaged in the four ACP activities were unaware they could record wishes or appoint decision-makers, or indicated providers had not initiated conversations. CONCLUSION: Relatively few inpatients had engaged in all four ACP activities. More inpatients had discussed end of life issues with family and appointed substitute decision makers, than completed written documents or talked with doctors. Community education and a more active role for community and hospital-based providers in supporting patients and families to collaboratively resolve end-of-life decisions may increase the probability wishes are known and followed. SN - 1471-2318 UR - https://www.unboundmedicine.com/medline/citation/31382893/Are_older_and_seriously_ill_inpatients_planning_ahead_for_future_medical_care L2 - https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1211-2 DB - PRIME DP - Unbound Medicine ER -