Qualitative Analysis of Community Dwelling Older Adults' Advance Care Planning Interviews: Patients Want a Chance.
Lucia D Wocial, Susan E Hickman, Kathleen Ziemba and 4 others
PMID 42363657WHAT IT FOUND
Older adults facing serious illness often chose full treatment and CPR because they wanted a chance to return to normal, even after acknowledging their illness was not curable and hearing that recovery after CPR was unlikely.
Key findings
01Many patients wanted advance care planning mainly to avoid unwanted treatment and feared a surrogate might choose something they did not want, but only 6 of 22 had potential surrogates participate.
02When told that choosing to maintain current health excluded CPR, many participants changed their preference to full interventions, saying they wanted a chance to return to their current life.
03Some patients could identify unacceptable future states, such as irreversible loss of mind, and at follow-up illness progression led one participant to clarify a current preference to avoid CPR.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was a convenience sample of 22 patients and 8 study partners from a larger study, selected because they were randomized to the intervention and alive at one year, so it may not represent all older adults with serious illness. Only participants with decision-making capacity were analysed, and those who were acutely ill, enrolled in hospice, or unable to complete activities in English were excluded. The sample was primarily female and white, and few study partners attended: 6 were present initially and 4 at follow-up. POST completion was optional, and only 11 patients completed one, so documented preferences may not reflect the full sample. The authors note that the RCAS model prepares non-clinician facilitators and emphasizes neutrality; clinicians may be more directive, which could change conversations.
The easy way to misread this
Do not conclude that patients who choose full interventions are uninformed or inconsistent. They heard that CPR survivors would be admitted to the ICU, need a ventilator, and have a low likelihood of recovery, yet many still wanted a chance to return to normal. This is a qualitative study of preferences, not evidence that CPR or full treatment improves outcomes.