The process of advance care planning involves getting information on the kinds of treatment patients are willing to receive. This includes deciding whether or not they wish certain treatments to be withheld should they be diagnosed with a terminal illness.
The Ohio State study, published in the American Journal of Hospice & Palliative Medicine, analyzed health records from 1,185 cancer patients who were receiving hospice care. They found that if these patients had a verified do-not-resuscitate order (DNR) before the last 30 days of their life, it reduced their chances of being hospitalized. Advanced care planning also aided in lowering their chances of being admitted to a hospital, especially if the planning was made at least six months prior to their death.
Advance care planning is necessary
“Once a terminally ill patient transitions into hospice care, the goal is to avoid hospitalizations and procedures that are unnecessary and unwanted,” said Laura Prater, lead study author and postdoctoral researcher at the Ohio State University College of Medicine.
Prater further stated that the goal of advance care planning is to prevent unwanted procedures and expenses that may deteriorate a person's quality of life. The goal here then is to respect the patient's wishes and to focus all of their efforts on managing pain and maintaining their quality of life until their very last breath.
The study accessed electronic health records from “a large academic medical center.” The data covers two whole years, from January 1, 2014, to December 31, 2015. It found 1,185 advanced cancer patients who were referred to hospice care. They then assessed how often these patients were admitted to hospitals and found that those who had advance care planning were less likely to be admitted in the last 30 days of their life. Those who had made plans at least six months prior to their death were even less likely to be hospitalized.
“Improving advance care planning processes prior to hospice referral holds promise for reducing end of life admissions,” wrote the researchers in the conclusion of their study.
Clear communication of a patient's wishes is extremely important
Seuli Bose-Brill, a senior study author and a primary care physician for Ohio State's Wexner Medical Center, stated that clearly passing along a patient's wishes to their health practitioners and other members of their care team is extremely important. It's important to have those kinds of conversations, which will include what a patient wants to happen when his or her illness becomes terminal.
Previous studies on advance care planning, along with analyses of electronic health records, have found that only around 13 to 44 percent of terminally ill patients have documented what kind of treatment they wish to receive in their end of life care. (Related: Music therapy improves psychological well-being, quality of life of terminally ill patients.)
This, according to Bose-Brill, is very important because, during times of crisis, terminally ill patients may not be in a position to advocate for their own wishes. Meanwhile, their closest family members, who would be in a position to decide for the patient, may either be “unsure, afraid or in disagreement.” However, if a patient's health records clearly state his wishes, the healthcare practitioners assigned to care for him will be more empowered to act on the patient's best interest.
“It's important to make [advance care planning] part of the process,” said Prater, “to look for ways to make sure that these conversations are happening consistently, early and often, even though they are complex and difficult conversations to have.”
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