Journal
JOURNAL OF PALLIATIVE MEDICINE
Volume 20, Issue 9, Pages 998-1003Publisher
MARY ANN LIEBERT, INC
DOI: 10.1089/jpm.2016.0530
Keywords
advanced care planning; advanced directive; end of life; palliative care; patient-centered
Categories
Funding
- AHRQ HHS [K08 HS024736] Funding Source: Medline
- NCI NIH HHS [L30 CA220744] Funding Source: Medline
Ask authors/readers for more resources
Background: Although previous research on advance care planning (ACP) has associated ACP with improved quality of care at the end of life, the appropriate use of ACP remains limited. Objective: To evaluate the impact of a pilot program using the Honoring Choices Wisconsin (HCW) model for ACP in a tertiary care setting, and to understand barriers to system-wide implementation. Design: Retrospective review of prospectively collected data. Setting/Subjects: Patients who received medical or surgical oncology care at Froedtert and the Medical College of Wisconsin. Measurements: Patient demographics, disease characteristics, patient satisfaction, and clinical outcomes. Results: Data from 69 patients who died following the implementation of the HCW program were reviewed; 24 patients were enrolled in the HCW program while 45 were not. Patients enrolled in HCW were proportionally less likely to be admitted to the ICU(12.5% vs. 17.8%) and were more likely to be do not resuscitate (87.5% vs. 80.0%), as well as have a completed ACP (83.3% vs. 79.1%). Furthermore, admission to a hospice was also higher among patients who were enrolled in the HCW program (79.2% vs. 25.6%), with patients enrolled in HCW more likely to die in hospice (70.8% vs. 53.3%). The HCW program was favorably viewed by patients, patient caregivers, and healthcare providers. Conclusions: Implementation of a facilitator-based ACP care model was associated with fewer ICU admissions, and a higher use of hospice care. System-level changes are required to overcome barriers to ACP that limit patients from receiving end-of-life care in accordance with their preferences.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available