Failure to Engage Hospitalized Elderly Patients and Their Families in Advanced Care Planning

Categories: Research.

Even though most people prefer to be cared for and die in their homes, the reality is that the majority of dying experiences occur in the hospital, and one fifth of these deaths occur in the intensive care unit which takes a toll on hospital resources as well as the emotional wellbeing of families.

Additionally, it is common practice to provide life support measures during the final stages of life, even though many patients and families would prefer comfort care to keep them pain free and content. According to this article, advanced care planning, or ACP, is “an ongoing process of reflection and communication in which a person who has decision-making capacity makes decisions regarding future health and/or professional care in the event that he or she becomes incapable of consenting to or refusing treatment or other care”.

The advance care planning process can involve many different parties; health care providers, family, friends, neighbours, and anyone else that the patient chooses to include. The process can end in a verbal or written plan, and may include treatment instructions, the patient’s personal values that they would like to be upheld, and the nomination of a person to be the decision maker if and when the patient becomes incapable of making their own decisions.

While it is possible that circumstances will change and things will not go according to plan, the emphasis that ACP places on patient-centred care where the patient and family’s wishes are upheld is associated with better quality of life for patients nearing the end-of-life phase as well as more peace of mind for families.

In this study of 278 elderly patients and 225 of their family members, only 47.9% of patients had completed an advanced care plan and 73.3% had named a decision maker for their health care needs when they became unable to decide on their own. More concerning was that only 30.3% of patients had discussed their advanced care plan with their family physician, and the agreement between the patients’ preferences for end of life care and the documentation in their medical records was 30.2%. This means that even though some patients might have expressed their wishes to their families, their health care team might not be aware of these wishes, which can lead to unwanted complications later on.

It is very important that healthcare providers and other individuals involved in hospice palliative care emphasize the importance of ACP, because it is so integral to a high-quality end-of-life experience for patients and their families.

The original study was published in Jama Internal Medicine.