The impact of advance care planning on end of life care in elderly patients: randomised controlled trial

Abstract

Objective To investigate the impact of advance care planning on end of life care in elderly patients.Design Prospective randomised controlled trial.Setting Single centre study in a university hospital in Melbourne, Australia.Participants 309 legally competent medical inpatients aged 80 or more and followed for six months or until death.Interventions Participants were randomised to receive usual care or usual care plus facilitated advance care planning. Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes.Main outcome measures The primary outcome was whether a patient’s end of life wishes were known and respected. Other outcomes included patient and family satisfaction with hospital stay and levels of stress, anxiety, and depression in relatives of patients who died.Results 154 of the 309 patients were randomised to advance care planning, 125 (81%) received advance care planning, and 108 (84%) expressed wishes or appointed a surrogate, or both. Of the 56 patients who died by six months, end of life wishes were much more likely to be known and followed in the intervention group (25/29, 86%) compared with the control group (8/27, 30%; P<0.001). In the intervention group, family members of patients who died had significantly less stress (intervention 5, control 15; P<0.001), anxiety (intervention 0, control 3; P=0.02), and depression (intervention 0, control 5; P=0.002) than those of the control patients. Patient and family satisfaction was higher in the intervention group.Conclusions Advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives.Trial registration Australian New Zealand clinical trials registry ACTRN12608000539336.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…Models for structuring initiatives to enhance care in the ICU highlight the importance of incorporating goals of care, along with prognosis, into treatment plans [642]. The use of proactive family care conferences to identify advance directives and treatment goals within 72 h of ICU admission has been demonstrated to promote communication and understanding between the patient's family and the treating team; improve family satisfaction; decrease stress, anxiety, and depression in surviving relatives; facilitate end-of-life decision-making; and shorten ICU LOS for patients who die in the ICU [643,644]. Promoting shared-decision-making with patients and families is beneficial in ensuring appropriate care in the ICU and that futile care is avoided [641,645,646].…”

Advance Care Planning for Adults With CKD: A Systematic Integrative Review

“…In general medical settings, ACP has been shown to increase patient and family satisfaction with care 10,11 and the likelihood that doctors and family members will understand and comply with patients' wishes for EOL care 10,[12][13][14] . It also increases the likelihood of a person dying in their preferred place, increases hospice use 14,15 , reduces hospitalisation 11,15 , leads to less 'aggressive' medical care at EOL 14,16,17 , and contributes to lower stress, anxiety and depression in surviving relatives 10,11,13,14 .…”

Financial Incentives to Increase Advance Care Planning Among Medicaid Beneficiaries: Lessons Learned From Two Pragmatic Randomized Trials

“…1,3 Although there is some controversy regarding the effectiveness of written advance directive documents, 4 a systematic review and meta-analysis of English language randomized trials concluded that ACP interventions focused on discussions improved concordance between patients' preferences and end-of-life (EOL) treatment. 5 The Centers for Disease Control and Prevention reports that only 30% of U.S. adults have some form of advance care plan, 6 and low-income, minority, and low-literacy populations are the least likely to have engaged in ACP discussions or documentation. 7e9 The traditional approach to promote ACP is through clinic or hospital-based education.…”