Advance Care Planning: A Retrospective Audit in a National Referral Center for Interstitial Lung Diseases.
Lian Trapman, Marieke Zwakman, Everlien de Graaf and 3 others
PMID 39401339WHAT IT FOUND
In 60 deceased patients with pulmonary fibrosis, 68% of clinical notes contained no advance care planning elements.
No chart documented all key items, and emotional topics like religion or personal representatives were never recorded, leaving end-of-life preferences largely undocumented.
Key findings
01The majority of coded conversation notes contained no elements of advance care planning, and no single patient chart documented every key element.
02Emotional elements such as religion and the existence of a personal representative were never documented in any patient chart.
03Documentation of resuscitation and artificial respiration preferences was present in fewer than half of the patient charts.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study relied entirely on retrospective chart reviews, meaning it only captured what was written down, not what was actually discussed with patients. The data was collected for clinical care rather than research purposes, leading to inconsistent documentation practices among different health care professionals. The study excluded the patient and family perspective, so it cannot assess whether patients felt their needs were met despite the lack of documentation. The sample size was small (60 patients) and drawn from a single center, limiting the generalizability of the findings to other settings.
Declared interests
The authors declared no potential conflicts of interest. The work was supported by the Pendersfonds, a patient organization for people with pulmonary fibrosis.
The easy way to misread this
Do not conclude that patients did not discuss these topics simply because they are absent from the charts. The audit reflects documentation habits and the lack of a standardized recording tool, not necessarily the absence of communication between clinicians and patients.