Abstract

PURPOSE:: Advance directives (AD) have been heralded as vehicles to promote patient autonomy and have been decried as ineffective. Efforts to improve advance care planning (ACP) and AD documents are wide ranging but have not been prospectively studied. MATERIALS AND METHODS:: In an institutional review board-approved, single-blind, randomized, controlled trial, we compared an interactive, educational ACP decision aid to standard ACP among patients with advanced cancer. We hypothesized that use of the decision aid would increase physician awareness of patients' health care wishes and increase physician adherence to patients' end-of-life wishes compared with standard ACP. RESULTS:: A total of 200 patients were randomly assigned to two study arms. We analyzed data from medical records and interviews with physicians and family members for 121 patients who died by August 2016. No differences in physician awareness or adherence were found between the ACP decision aid and standard ACP groups. End-of-life treatment wishes and discussion of wishes were documented for 70% and 64% of the patients, respectively, but only 35% had an actual AD in the medical record. According to family members, end-of-life care was consistent with the patients' stated wishes 94% of the time. Similarly, according to physicians, it was consistent for 98%. However, according to AD documents, delivered care was consistent with desired care in only 65%. Considerably fewer patients than predicted died, and data from physicians were difficult to obtain. CONCLUSION:: ACP type did not influence documentation of patient wishes or end-of-life care received. Future prospective studies must account for challenges in prognostication and point-of-care data collection at the end of life.

Original languageEnglish (US)
Pages (from-to)e65-e73
JournalJournal of Oncology Practice
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2019

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Advance Care Planning
Advance Directives
Physicians
Decision Support Techniques
Neoplasms
Terminal Care
Medical Records
Point-of-Care Systems
Research Ethics Committees
Patient Compliance
Documentation
Patient Care
Randomized Controlled Trials
Prospective Studies
Interviews
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

@article{1b3304be6f884a24a2a913d9146cd61d,
title = "Advance Care Planning Among Patients With Advanced Cancer",
abstract = "PURPOSE:: Advance directives (AD) have been heralded as vehicles to promote patient autonomy and have been decried as ineffective. Efforts to improve advance care planning (ACP) and AD documents are wide ranging but have not been prospectively studied. MATERIALS AND METHODS:: In an institutional review board-approved, single-blind, randomized, controlled trial, we compared an interactive, educational ACP decision aid to standard ACP among patients with advanced cancer. We hypothesized that use of the decision aid would increase physician awareness of patients' health care wishes and increase physician adherence to patients' end-of-life wishes compared with standard ACP. RESULTS:: A total of 200 patients were randomly assigned to two study arms. We analyzed data from medical records and interviews with physicians and family members for 121 patients who died by August 2016. No differences in physician awareness or adherence were found between the ACP decision aid and standard ACP groups. End-of-life treatment wishes and discussion of wishes were documented for 70{\%} and 64{\%} of the patients, respectively, but only 35{\%} had an actual AD in the medical record. According to family members, end-of-life care was consistent with the patients' stated wishes 94{\%} of the time. Similarly, according to physicians, it was consistent for 98{\%}. However, according to AD documents, delivered care was consistent with desired care in only 65{\%}. Considerably fewer patients than predicted died, and data from physicians were difficult to obtain. CONCLUSION:: ACP type did not influence documentation of patient wishes or end-of-life care received. Future prospective studies must account for challenges in prognostication and point-of-care data collection at the end of life.",
author = "Schubart, {Jane R.} and Benjamin Levi and Bain, {Megan M.} and Elana Farace and Michael Green",
year = "2019",
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Advance Care Planning Among Patients With Advanced Cancer. / Schubart, Jane R.; Levi, Benjamin; Bain, Megan M.; Farace, Elana; Green, Michael.

In: Journal of Oncology Practice, Vol. 15, No. 1, 01.01.2019, p. e65-e73.

Research output: Contribution to journalArticle

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T1 - Advance Care Planning Among Patients With Advanced Cancer

AU - Schubart, Jane R.

AU - Levi, Benjamin

AU - Bain, Megan M.

AU - Farace, Elana

AU - Green, Michael

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N2 - PURPOSE:: Advance directives (AD) have been heralded as vehicles to promote patient autonomy and have been decried as ineffective. Efforts to improve advance care planning (ACP) and AD documents are wide ranging but have not been prospectively studied. MATERIALS AND METHODS:: In an institutional review board-approved, single-blind, randomized, controlled trial, we compared an interactive, educational ACP decision aid to standard ACP among patients with advanced cancer. We hypothesized that use of the decision aid would increase physician awareness of patients' health care wishes and increase physician adherence to patients' end-of-life wishes compared with standard ACP. RESULTS:: A total of 200 patients were randomly assigned to two study arms. We analyzed data from medical records and interviews with physicians and family members for 121 patients who died by August 2016. No differences in physician awareness or adherence were found between the ACP decision aid and standard ACP groups. End-of-life treatment wishes and discussion of wishes were documented for 70% and 64% of the patients, respectively, but only 35% had an actual AD in the medical record. According to family members, end-of-life care was consistent with the patients' stated wishes 94% of the time. Similarly, according to physicians, it was consistent for 98%. However, according to AD documents, delivered care was consistent with desired care in only 65%. Considerably fewer patients than predicted died, and data from physicians were difficult to obtain. CONCLUSION:: ACP type did not influence documentation of patient wishes or end-of-life care received. Future prospective studies must account for challenges in prognostication and point-of-care data collection at the end of life.

AB - PURPOSE:: Advance directives (AD) have been heralded as vehicles to promote patient autonomy and have been decried as ineffective. Efforts to improve advance care planning (ACP) and AD documents are wide ranging but have not been prospectively studied. MATERIALS AND METHODS:: In an institutional review board-approved, single-blind, randomized, controlled trial, we compared an interactive, educational ACP decision aid to standard ACP among patients with advanced cancer. We hypothesized that use of the decision aid would increase physician awareness of patients' health care wishes and increase physician adherence to patients' end-of-life wishes compared with standard ACP. RESULTS:: A total of 200 patients were randomly assigned to two study arms. We analyzed data from medical records and interviews with physicians and family members for 121 patients who died by August 2016. No differences in physician awareness or adherence were found between the ACP decision aid and standard ACP groups. End-of-life treatment wishes and discussion of wishes were documented for 70% and 64% of the patients, respectively, but only 35% had an actual AD in the medical record. According to family members, end-of-life care was consistent with the patients' stated wishes 94% of the time. Similarly, according to physicians, it was consistent for 98%. However, according to AD documents, delivered care was consistent with desired care in only 65%. Considerably fewer patients than predicted died, and data from physicians were difficult to obtain. CONCLUSION:: ACP type did not influence documentation of patient wishes or end-of-life care received. Future prospective studies must account for challenges in prognostication and point-of-care data collection at the end of life.

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