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Advance care planning for the severely ill in the hospital: a randomized trial


Krones, Tanja; Budilivschi, Ana; Karzig, Isabelle; Otto, Theodore; Valeri, Fabio; Biller-Andorno, Nikola; Mitchell, Christine; Loupatatzis, Barbara (2022). Advance care planning for the severely ill in the hospital: a randomized trial. BMJ Supportive & Palliative Care, 12(e3):e411-e423.

Abstract

OBJECTIVES: To investigate the impact of advance care planning (ACP) including decision aids for severely ill medical inpatients.
METHODS: Single-centre randomised controlled trial at a Swiss university hospital. Patients were randomly assigned (1:1) to receive an extra consultation with the hospital social service or a consultation with in-house facilitators trained according to an internationally established ACP programme. Trial participants with the exception of the observers were fully blinded. 115 competent severely ill adults, their surrogates and their attending physicians were enrolled and followed for 6 months after discharge or 3 months after death. The patient's wishes regarding resuscitation (primary outcome), last place of care and other end-of-life wishes were recorded. Knowledge and respect of the patient's wishes by the surrogates and attending physician were monitored.
RESULTS: Compared with controls, 6 months after the intervention, fewer patients wished to be resuscitated or were undecided (p=0.01), resuscitation wishes were documented more frequently (89% vs 64%, p=0.02) and surrogates and/or attending physicians had greater knowledge of the patient's wishes (62% vs 30%, p=0.01). Groups were not different with regard to wishes being fulfilled, with the exception of last place of care being achieved more frequently in the intervention group (29% vs 11 %, p=0.05).
CONCLUSION: ACP including decision aids offered to severely ill medical inpatients leads to greater knowledge, documentation and respect of treatment and end-of-life wishes. Introducing ACP to these patients however may be too late for many patients. Early integration of ACP during the illness trajectory and a broader regional approach may be more appropriate.

Abstract

OBJECTIVES: To investigate the impact of advance care planning (ACP) including decision aids for severely ill medical inpatients.
METHODS: Single-centre randomised controlled trial at a Swiss university hospital. Patients were randomly assigned (1:1) to receive an extra consultation with the hospital social service or a consultation with in-house facilitators trained according to an internationally established ACP programme. Trial participants with the exception of the observers were fully blinded. 115 competent severely ill adults, their surrogates and their attending physicians were enrolled and followed for 6 months after discharge or 3 months after death. The patient's wishes regarding resuscitation (primary outcome), last place of care and other end-of-life wishes were recorded. Knowledge and respect of the patient's wishes by the surrogates and attending physician were monitored.
RESULTS: Compared with controls, 6 months after the intervention, fewer patients wished to be resuscitated or were undecided (p=0.01), resuscitation wishes were documented more frequently (89% vs 64%, p=0.02) and surrogates and/or attending physicians had greater knowledge of the patient's wishes (62% vs 30%, p=0.01). Groups were not different with regard to wishes being fulfilled, with the exception of last place of care being achieved more frequently in the intervention group (29% vs 11 %, p=0.05).
CONCLUSION: ACP including decision aids offered to severely ill medical inpatients leads to greater knowledge, documentation and respect of treatment and end-of-life wishes. Introducing ACP to these patients however may be too late for many patients. Early integration of ACP during the illness trajectory and a broader regional approach may be more appropriate.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Biomedical Ethics and History of Medicine
04 Faculty of Medicine > University Hospital Zurich > Institute of General Practice
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Medicine (miscellaneous)
Health Sciences > Oncology (nursing)
Health Sciences > Medical and Surgical Nursing
Language:English
Date:1 August 2022
Deposited On:07 Jun 2019 14:18
Last Modified:06 Aug 2022 01:00
Publisher:BMJ Publishing Group
ISSN:2045-435X
OA Status:Closed
Publisher DOI:https://doi.org/10.1136/bmjspcare-2017-001489
PubMed ID:30665882