Early intervention in planning end-of-life care with ambulatory geriatric patients: results of a pilot trial.

Full Abstract

BACKGROUND:
A large discrepancy exists between the wishes of dying patients and their actual end-of-life care. However, retrospective clinical experience suggests that early advance care planning (ACP) can markedly reduce this discrepancy. This article describes a randomized trial to evaluate the short-term clinical utility of early ACP. We also assessed the feasibility of performing a larger prospective study to document long-term outcomes.

METHODS:
Ambulatory geriatric patients (N = 61) were randomized to either a control group, which received only a Massachusetts Health Care Proxy form to complete, or an intervention group, in which each patient and health care agent discussed ACP with a trained nurse facilitator. The benefits and burdens of life-sustaining treatments were discussed, and patient goals and preferences for these treatments were documented.

RESULTS:
Two-month follow-up revealed that the intervention achieved higher congruence between agents and patients in their understanding of patients' end-of-life care preferences, with 76% (19/25) in complete agreement vs 55% (12/22) of the controls (effect size [ES] = -0.43). There was also a greater increase in patient knowledge about ACP in the intervention group (ES = 0.22). Intervention patients became less willing to undergo life-sustaining treatments for a new serious medical problem (ES = -0.25), more willing to undergo such treatments for an incurable progressive disease (ES = 0.24), and less willing to tolerate poor health states (ES = -0.78). Practical insights were gained about how to conduct a larger study more effectively.

CONCLUSION:
A facilitated discussion about end-of-life care between patients and their health care agents helps define and document the patient's wishes for both patient and agent.

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Author information

Author/s: Schwartz, Carolyn E (CE); Wheeler, H Brownell (HB); Hammes, Bernard (B); Basque, Noreen (N); Edmunds, Jean (J); Reed, George (G); Ma, Yunsheng (Y); Li, Lynn (L); Tabloski, Patricia (P); Yanko, Julianne (J); UMass End-of-Life Working Group;

Affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA 01742, USA. carolyn.schwartz(-atsign-)umassmed.edu

Journal and publication information

Publication Type: Clinical Trial; Comparative Study; Evaluation Studies; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: 2002-Jul; vol 162 (issue 14) : pp 1611-8

Dates: Created 2002/07/18; Completed 2002/08/14; Revised 2007/11/15;

PMID: 12123405, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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