Early intervention in planning end-of-life care with ambulatory geriatric patients: results of a pilot trial.
Arch Intern Med
; 162(14): 1611-8, 2002 Jul 22.
Article
en En
| MEDLINE
| ID: mdl-12123405
ABSTRACT
BACKGROUND:
A large discrepancy exists between the wishes of dying patients and their actual end-of-life care. However, retrospective clinical experience suggests that early advance care planning (ACP) can markedly reduce this discrepancy. This article describes a randomized trial to evaluate the short-term clinical utility of early ACP. We also assessed the feasibility of performing a larger prospective study to document long-term outcomes.METHODS:
Ambulatory geriatric patients (N = 61) were randomized to either a control group, which received only a Massachusetts Health Care Proxy form to complete, or an intervention group, in which each patient and health care agent discussed ACP with a trained nurse facilitator. The benefits and burdens of life-sustaining treatments were discussed, and patient goals and preferences for these treatments were documented.RESULTS:
Two-month follow-up revealed that the intervention achieved higher congruence between agents and patients in their understanding of patients' end-of-life care preferences, with 76% (19/25) in complete agreement vs 55% (12/22) of the controls (effect size [ES] = -0.43). There was also a greater increase in patient knowledge about ACP in the intervention group (ES = 0.22). Intervention patients became less willing to undergo life-sustaining treatments for a new serious medical problem (ES = -0.25), more willing to undergo such treatments for an incurable progressive disease (ES = 0.24), and less willing to tolerate poor health states (ES = -0.78). Practical insights were gained about how to conduct a larger study more effectively.CONCLUSION:
A facilitated discussion about end-of-life care between patients and their health care agents helps define and document the patient's wishes for both patient and agent.Palabras clave
Buscar en Google
Bases de datos:
MEDLINE
Asunto principal:
Planificación de Atención al Paciente
/
Cuidado Terminal
/
Enfermo Terminal
/
Planificación Anticipada de Atención
/
Atención Ambulatoria
Tipo de estudio:
Clinical_trials
/
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
Límite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Arch Intern Med
Año:
2002
Tipo del documento:
Article
País de afiliación:
Estados Unidos