The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients With Multimorbidity.
Cara L McDermott, Ruth A Engelberg, Nita Khandelwal and 5 others
PMID 33084357WHAT IT FOUND
Patients with four or more chronic conditions were hospitalized and admitted to the ICU more often at end of life.
Advance care planning documented more than 30 days before death was associated with lower odds of these high-intensity interventions across dementia, heart failure, pulmonary disease, and renal disease.
Key findings
01Multimorbidity was associated with higher odds of inpatient hospitalization and ICU admission at end of life across all four primary conditions studied.
02Advance care planning documentation more than 30 days before death was associated with significantly lower odds of hospitalization, ICU admission, and in-hospital death for patients with heart failure, pulmonary disease, and dementia.
03For patients with renal disease without multimorbidity, advance care planning was associated with lower odds of in-hospital death but showed no significant association with ICU or inpatient admission.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study only included patients who died in Washington State and whose care was recorded in a specific healthcare system, potentially missing hospitalizations or ICU admissions that occurred in other facilities or states. ACP documentation was defined strictly by the presence of specific legal or medical orders in the electronic health record, which may have missed verbal discussions or informal plans that influenced care. The analysis relied on ICD codes to identify conditions, which confirms diagnosis but does not account for the severity of the illness or the patient's functional status. As an observational study of deceased patients, it cannot prove that ACP documentation directly caused the reduction in high-intensity care, only that the two are associated.
Declared interests
No specific funding sources or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not assume that documenting advance care planning guarantees a reduction in ICU admissions for all patients. The study found that for patients with renal disease who did not have multimorbidity, ACP was associated with lower in-hospital death but showed no significant association with reduced ICU or inpatient admissions.