SLIDE 11 8/7/2018 11 Benefits of ACP
Patients who have advance care planning or EOL
conversations with their provider are:
Less likely to: Receive intense interventions (mechanical ventilation, CPR, ICU
death, feeding tubes) (Zhang et al. 2009, Teno et al 2008, Wright et al. 2008,
Brinkman-Stoppelenberg 2014)
More likely to: Receive outpatient hospice and be referred to hospice earlier (Zhang
et al. 2009, Wright et al. 2008) Have their wishes known and followed (Detering et al. 2010; Houbin 2014) Have caregivers who are satisfied with the quality of their loved
- ne’s death (Detering et al. 2010)
Audience Poll
In my practice, I aim to have advance care planning conversations with:
- A. None of my patients
- B. All my patients over 65 years old
- C. My patients who are terminally ill
- D. Both 2 and 3
- E. All my patients regardless of age
N
e
m y p a t i e n t s A l l m y p a t i e n t s
e r 6 5 y e a r s
d M y p a t i e n t s w h
r e t e r m i n a l l y i l l B
h 2 a n d 3 A l l m y p a t i e n t s r e g a r d l e s s
a g e
4% 2% 28% 50% 16%
ACP Practices in Primary Care
Glaudermans et al. (2015) Fam Practice
- Systematic review of 10 studies (5 US) among PCPs providing
care for patients living in the community or an assisted living
- ACP most frequently done with patients with cancer,
Alzheimer’s dementia, or other terminal illness
- Of patients who died of non-sudden deaths, one-third had ACP
- Provider-reported ACP rates higher than patient-reported ones
- Lack of systematic approach; hard to judge when to initiate
- Patients want to discuss, even if healthy; feel it is responsibility
- f provider to bring up
ACP Documentation
Include on problem list; be
specific
Health systems streamlining
EMR ACP documentation
Ideally, complete advance
directive and medical order (for patients with less than 1y prognosis; in states where available)
www.polst.org
