Advance Care Planning Engagement of Older Adults in the Emergency Department.
Adrian D Haimovich, Kenji Numata, Justin Wolozin and 8 others
PMID 40271984WHAT IT FOUND
Older emergency department patients rated advance care planning engagement 4.1 of 5, but only 37 (40%) had talked to doctors about end-of-life wishes.
They preferred clinician conversations over websites or videos.
Key findings
01The primary advance care planning engagement survey mean was 4.1 (95% CI: 4.0 to 4.2) on a five-point scale.
02The lowest reported completion was talking to doctors about end-of-life wishes: 37 participants (40%); the highest was asking someone to be a medical decision maker: 80 participants (82%).
03Of 99 participants, 85 (86%) had a documented health care proxy in the EHR and 9 (9.1%) had EHR documentation of end-of-life wishes; there was no association between patient-reported signed documents and EHR documentation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used a convenience sample from a single academic emergency department, so it may not represent older adults in other settings. Only English-speaking patients were included, and people with dementia, cognitive impairment, clinical instability, lack of capacity, or incarceration were excluded. Only 19% of participants had a serious illness, so results may differ in populations with more or less serious illness. The electronic health record had limited scope, including select primary care practices and a single tertiary care hospital. Researchers reviewed only structured electronic health record fields, so advance care planning information in notes or other areas was not counted. The study did not collect educational attainment, which may have influenced responses. It was a survey of patient perspectives, not a test of an intervention or communication method.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the 4.1 of 5 engagement score as evidence that patients have discussed end-of-life wishes with doctors. Only 37 (40%) had done so, and this survey did not test an intervention.