Context: As patients approach the end of life, discussion of their treatment goals is essential to avoid unnecessary suffering and deliver care in a manner consistent with their overall values.
Objectives: Implement a multipronged approach to improve the rates of advance care planning (ACP) documentation among providers admitting patients with cancer to the intensive care unit (ICU) from the emergency department (ED).
Methods: We developed multiple interventions including the development of a best-practice advisory to alert providers when patients had previous do-not-resuscitate orders; standardization of ACP documentation; early oncologist involvement in goals-of-care conversations with patients; a survey of ED providers to identify barriers to success; and positive reinforcement strategies aimed at improving the rates of ACP documentation in patients admitted from the ED to the ICU.
Results: Prior to our interventions, only 13% of patients admitted to the ICU from the ED had ACP notes. This percentage increased to 90% by the last month of our project.
Conclusion: Through our multipronged approach, we significantly improved the rates of ACP documentation among providers admitting patients from the ED to the ICU.
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| http://dx.doi.org/10.1016/j.jpainsymman.2024.05.029 | DOI Listing |
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Improving Advanced Care Planning Discussions at an Internal Medicine Clinic.
Cureus
December 2024
Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA.
Objective: The project aimed to standardize advanced care planning (ACP) at an internal medicine clinic by initiating physician-patient communication regarding the patient's knowledge, understanding, and openness to pursuing advanced medical directives.
Methods: Data collection was conducted from February 1 to April 1, 2024, with the study concluding on April 24, 2024. ACP was facilitated through an initial standardized six-question pre-intervention survey in both English and Spanish.
Advance Care Planning Billing Codes Associated With Decreased Healthcare Utilization in Neurological Disease.
J Healthc Manag
January 2025
Gregory Brown, MD, PhD, Department of Medicine, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania; Sol De Jesus, MD, Department of Neurology, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania; Emily Leboffe, MD, Department of Medicine, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania; Andy Esch, MD, Center to Advance Palliative Care, New York, New York; and Kristina Newport, MD, Department of Medicine, Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Goals: Advance care planning (ACP) procedure codes have been established to reimburse meaningful care goal discussions; however, the utilization frequency of these codes in neurological disease is unknown. The objective of this study is to identify the association between ACP codes and healthcare utilization in chronic neurodegenerative diseases.
Methods: This is a multicenter cohort study using real-world electronic health data.
Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI): Protocol for a cluster randomized controlled cross-over trial of life story work and facilitated advance care planning among older Australian adults in community settings.
Contemp Clin Trials
December 2024
Neuroscience Research Australia (NeuRA), Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia. Electronic address:
Article Synopsis
- Advance care planning (ACP) is crucial for older adults but is not widely adopted in community aged care settings; recent studies suggest that holistic, person-centered approaches may enhance engagement.
- The EARLI trial is a randomized study involving 12 aged care organizations in Australia, aiming to test a combined life story work and facilitated ACP intervention over two years with participants aged 65 and older.
- By assessing outcomes like ACP engagement, documentation, and emotional well-being, the trial seeks to demonstrate that personalized approaches can improve ACP uptake and ultimately benefit older adults and their families.
Advance Care Planning in Palliative Care in Asia: Barriers and Implications.
J Hosp Palliat Care
December 2024
Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si and Department of Medicine, College of Medicine, Dongguk University, Seoul, Korea.
Advance care planning (ACP) in palliative care is essential for patient autonomy and quality of dying. This review explores ACP practices in South Korea, Japan, and Taiwan, highlighting how legislation and cultural values shape those practices. In these three sectors, which are influenced by Confucian values, family involvement plays a significant role in decision-making.
View Article and Find Full Text PDFImportance: Primary care is a key setting for advance care planning (ACP).
Objective: To test the effects of a multicomponent primary care-based ACP intervention (SHARING Choices) on documented end-of-life preferences and potentially burdensome care at end of life.
Design, Setting, And Participants: This pragmatic cluster randomized clinical trial in primary care practices from 2 health systems was conducted between March 2021 and April 2022.
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