Advanced Care Directives: Can We Do Better ?

2008 ◽  
Vol 14 (6) ◽  
pp. S116-S117
Author(s):  
Marlena V. Habal ◽  
Vaska Micevski ◽  
Sarah Greenwood ◽  
Diego H. Delgado ◽  
Heather J. Ross
Keyword(s):  
Advanced Care Directives

Outcomes and Cost of Patients With Terminal Cancer Admitted to Acute Care in the Final 2 Weeks of Life: A Retrospective Chart Review

2019 ◽  
Vol 36 (11) ◽  
pp. 1020-1025 ◽  
Author(s):  
Kwadwo Kyeremanteng ◽  
Abid Ismail ◽  
Cynthia Wan ◽  
Kednapa Thavorn ◽  
Gianni D’Egidio
Keyword(s):  
Chart Review ◽  
Hospice Care ◽  
Hospital Costs ◽  
Retrospective Chart Review ◽  
Medical Doctor ◽  
Medical Services ◽  
Ottawa Hospital ◽  
Hospitalization Costs ◽  
Advanced Care Directives ◽  
Eol Care

Background: Patients with terminal conditions are often admitted to the emergency department (ED) for acute medical services, but studies have suggested that multiple ED admissions may negatively impact end-of-life (EOL) care. Research have shown that incorporating palliative care (PC) is integral to optimal EOL care, but it is an aspect of medical practice that is often neglected. The current study sought to provide an overview of health outcomes and hospital costs of patients with cancer admitted to The Ottawa Hospital and/or received acute medical services during their final 2 weeks of life. Cost comparisons and estimates were made between hospital and hospice expenditures. Methods: We conducted a retrospective chart review of palliative patients who died at The Ottawa Hospital in 2012. A total of 130 patients who visited the ED within 2 weeks of death were included in the analyses. Results: In this cohort of patients, 71% of admitted patients did not have advanced care directives and 85% experienced a metastasis, but only 18% had a PC medical doctor. Patients were hospitalized, on average, for 7 days and hospitalization costs exceeded the estimated hospice cost by approximately 2.5 times (Can$1 041 170.00 at Can$8009.00/patient vs Can$401 570.00 at Can$3089.00/patient, respectively). Conclusion: Our study highlighted the importance of PC integration in high-risk patients, such as those in oncology. Patients in our sample had minimal PC involvement, low advanced care directives, and accrued high costs. Based on our analyses, we concluded that these patients would have likely benefited more from hospice care rather than hospitalization.

scholarly journals Advanced Care Directives: Overcoming the Obstacles

2015 ◽  
Vol 7 (1) ◽  
pp. 91-94 ◽  
Author(s):  
Sarah Leatherman Allen ◽  
Kimberly S. Davis ◽  
Paul C. Rousseau ◽  
Patty J. Iverson ◽  
Patrick D. Mauldin ◽  
...  
Keyword(s):  
End Of Life ◽  
Internal Medicine Resident ◽  
Living Will ◽  
Clinical Environment ◽  
Family Meeting ◽  
Continuity Clinic ◽  
Medicine Resident ◽  
Resident Physicians ◽  
Advanced Care Directives ◽  
Resident Continuity Clinic

Abstract Background Advanced care directives (ACDs) and end-of-life discussions are important and typically difficult to initiate because of the sensitive nature of the topic and competing clinical priorities. Resident physicians need to have these conversations but often do not in their continuity clinics. Objective We implemented a program to (1) increase physician opportunity to discuss end-of-life wishes with their patients, and (2) improve residents' confidence in leading discussions regarding ACDs. Intervention A total of 95 residents in an academic outpatient internal medicine resident continuity clinic participated in a formalized curriculum (didactic sessions, simulations, and academic detailing). Clinic workflow alterations prompted the staff to question if patients had an ACD or living will, and then cued residents to discuss these issues with the patients if they did not. Results Of the 77% of patients who were asked about ACDs, 74% had no ACD but were interested in discussing this topic. After our intervention, 65% (62 of 95) of our residents reported having at least 1 outpatient discussion with their patients. Residents reported increased confidence directing and discussing advanced care planning with older patients and conducting a family meeting (P < .01). Conclusions By delivering a formalized curriculum and creating a clinical environment that supports such discussions, resident physicians had more ACD discussions with their patients and reported increased confidence. When provided information and opportunity, patients consistently expressed interest in talking with their physician about their advanced care wishes.

Use of advanced care directives by ambulatory chemotherapy patients with malignant disease: Likely predictors and impact of physician intervention

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20544-e20544
Author(s):  
S. R. Hassan ◽  
D. Kilari ◽  
A. Politsmakher ◽  
S. Chakraborthy ◽  
J. Fogel ◽  
...  
Keyword(s):  
Performance Status ◽  
Living Alone ◽  
Inpatient Setting ◽  
Family Status ◽  
Advanced Directives ◽  
The Third ◽  
Education Status ◽  
Advanced Care Directives ◽  
Chemotherapy Patients ◽  
Thoughtful Discussion

e20544 Background: Despite their poor prognosis, few cancer patients have advanced care directives (ACD). Most often, ACD is discussed in an inpatient setting, when the patient is acutely ill and often nearing the end of life. Timely and thoughtful discussion would be better accomplished for both the patient and the family before such hospitalization. Methods: Interviews were done in 108 outpatients in an ambulatory chemotherapy center. A questionnaire noted whether ACD was executed or not, demographics (including education, religion and insurance status), performance status, characteristics of their cancer, and family status. All patients without ACD were counseled on the importance of ACD. The presence of an ACD was documented at each visit. Statistical comparison of patients with and without ACD at each visit was done. Results: The following variables were significantly associated with having an ACD at the first visit. Patients living alone could not be included in the logistic regression model, as none had advanced directives. However ACD execution differed significantly in patients living alone, compared with those living with family (0/33 vs 15/75; p=0.005). An additional 42 patients executed an ACD by the third visit. At the third visit, only living with family vs living alone remained significantly associated with having ACD. [OR=3.17 95% CI: 1.34, 7.50; p=0.009]. Conclusions: The following findings are noteworthy. Only 15/108 (14%) cancer outpatients had ACD. This disturbingly low rate increased to 55/108 (51%) after physician- initiated discussion. The following characteristics predicted not having ACD before intervention: younger age, absence of metastasis, better performance status, lower education status and living alone. After several physician interventions, only living alone remained a significant barrier to ACD execution by cancer outpatients. These results provide new insights and strategies to encourage improved advanced directive execution. [Table: see text] No significant financial relationships to disclose.

Prevalence and factors associated with advanced care directives in a motor neuron disease multidisciplinary clinic in Australia

2020 ◽  
pp. postgradmedj-2020-138184
Author(s):  
Chun Seng Phua ◽  
Aloysius Ng ◽  
Christopher Brooks ◽  
Zinta Harrington ◽  
Hima Vedam ◽  
...  
Keyword(s):  
Decision Making ◽  
Motor Neuron ◽  
Motor Neuron Disease ◽  
Hospital Admissions ◽  
Neurodegenerative Disorder ◽  
Symptom Duration ◽  
Location Of Death ◽  
Advanced Care Directives ◽  
English Speaking ◽  
The Relationship

ObjectivesMotor neuron disease (MND) is a neurodegenerative disorder leading to functional decline and death. Multidisciplinary MND clinics provide an integrated approach to management and facilitate discussion on advanced care directives (ACDs). The study objectives are to analyse (1) the prevalence of ACD in our MND clinic, (2) the relationship between ACD and patient demographics and (3) the relationship between ACD decision-making and variables such as NIV, PEG, hospital admissions and location of death.MethodsUsing clinic records, all patients who attended the MND clinic in Liverpool Hospital between November 2014 and November 2019 were analysed. Data include MND subtypes, symptom onset to time of diagnosis, time of diagnosis to death, location and reason of death. ACD prevalence, non-invasive ventilation (NIV) and percutaneous endoscopic gastrostomy (PEG) requirements were analysed.ResultsThere were 78 patients; M:F=1:1. 44 (56%) patients were limb onset, 28 (36%) bulbar onset, 4 primary lateral sclerosis and 2 flail limb syndrome presentations. 27% patients completed ACDs, while 32% patients declined ACDs. Patients born in Australia or in a majority English-speaking country were more likely to complete ACDs compared to those born in a non-English-speaking country. There was no significant correlation between ACD completion and age, gender, MND subtype, symptom duration, NIV, PEG feeding, location of death.ConclusionOne-quarter of patients completed ACDs. ACDs did not correlate with patient age, gender, MND subtype and symptom duration or decision-making regarding NIV, PEG feeding or location of death. Further studies are needed to address factors influencing patients’ decisions regarding ACDs.

How Aware of Advanced Care Directives Are Heart Failure Patients, and Are They Using Them?

2011 ◽  
Vol 27 (3) ◽  
pp. 376-381 ◽  
Author(s):  
Marlena V. Habal ◽  
Vaska Micevski ◽  
Sarah Greenwood ◽  
Diego H. Delgado ◽  
Heather J. Ross
Keyword(s):  
Heart Failure ◽  
Heart Failure Patients ◽  
Advanced Care Directives

PI CME driven interventions in an outpatient oncology practice to improve awareness and utilization of advanced care directives.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e20508-e20508
Author(s):  
Elizabeth Ann Whitt ◽  
Monica Copp ◽  
Doug Smith ◽  
Debbie ELAINE Bihl ◽  
Ganapathy S. Krishnan ◽  
...  
Keyword(s):  
Advanced Care Directives ◽  
Oncology Practice
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