Journal article
Advance care planning for the severely ill in the hospital: a randomized trial.
- Krones T Head Clinical Ethics, University Hospital Zürich/Institute of Biomedical Ethics and History of Medicine University of Zürich, Zürich, Switzerland tanja.krones@usz.ch.
- Budilivschi A Psychologist, Clinical Ethics, University Hospital Zürich, Zürich, Switzerland.
- Karzig I Emergency specialist nurse, Clinical Ethics, University Hospital Zürich/Institute of Biomedical Ethics and History of Medicine University of Zürich, Zürich, Switzerland.
- Otto T Social Worker and Intensive Care Nurse, Clinical Ethics, University Hospital Zürich/Institute of Biomedical Ethics and History of Medicine University of Zürich, Zürich, Switzerland.
- Valeri F Statistician, Institute of Primary Care, University of Zürich, Zürich, Switzerland.
- Biller-Andorno N Director of the Institute of Biomedical Ethics and History of Medicine, University of Zürich, Zürich, Switzerland.
- Mitchell C Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA.
- Loupatatzis B Palliative Care Physician, Palliative Care Unit, University Hospital Zürich, Zürich, Switzerland.
- 2019-01-23
Published in:
- BMJ supportive & palliative care. - 2019
advance care planning
decision aid
last place-of-care
pragmatic trial
randomized trial
resuscitation
shared decision-making
English
OBJECTIVES
To investigate the impact of advance care planning (ACP) including decision aids for severely ill medical inpatients.
METHODS
Single-centre randomised controlled trial at a Swiss university hospital. Patients were randomly assigned (1:1) to receive an extra consultation with the hospital social service or a consultation with in-house facilitators trained according to an internationally established ACP programme. Trial participants with the exception of the observers were fully blinded. 115 competent severely ill adults, their surrogates and their attending physicians were enrolled and followed for 6 months after discharge or 3 months after death. The patient's wishes regarding resuscitation (primary outcome), last place of care and other end-of-life wishes were recorded. Knowledge and respect of the patient's wishes by the surrogates and attending physician were monitored.
RESULTS
Compared with controls, 6 months after the intervention, fewer patients wished to be resuscitated or were undecided (p=0.01), resuscitation wishes were documented more frequently (89% vs 64%, p=0.02) and surrogates and/or attending physicians had greater knowledge of the patient's wishes (62% vs 30%, p=0.01). Groups were not different with regard to wishes being fulfilled, with the exception of last place of care being achieved more frequently in the intervention group (29% vs 11 %, p=0.05).
CONCLUSION
ACP including decision aids offered to severely ill medical inpatients leads to greater knowledge, documentation and respect of treatment and end-of-life wishes. Introducing ACP to these patients however may be too late for many patients. Early integration of ACP during the illness trajectory and a broader regional approach may be more appropriate.
To investigate the impact of advance care planning (ACP) including decision aids for severely ill medical inpatients.
METHODS
Single-centre randomised controlled trial at a Swiss university hospital. Patients were randomly assigned (1:1) to receive an extra consultation with the hospital social service or a consultation with in-house facilitators trained according to an internationally established ACP programme. Trial participants with the exception of the observers were fully blinded. 115 competent severely ill adults, their surrogates and their attending physicians were enrolled and followed for 6 months after discharge or 3 months after death. The patient's wishes regarding resuscitation (primary outcome), last place of care and other end-of-life wishes were recorded. Knowledge and respect of the patient's wishes by the surrogates and attending physician were monitored.
RESULTS
Compared with controls, 6 months after the intervention, fewer patients wished to be resuscitated or were undecided (p=0.01), resuscitation wishes were documented more frequently (89% vs 64%, p=0.02) and surrogates and/or attending physicians had greater knowledge of the patient's wishes (62% vs 30%, p=0.01). Groups were not different with regard to wishes being fulfilled, with the exception of last place of care being achieved more frequently in the intervention group (29% vs 11 %, p=0.05).
CONCLUSION
ACP including decision aids offered to severely ill medical inpatients leads to greater knowledge, documentation and respect of treatment and end-of-life wishes. Introducing ACP to these patients however may be too late for many patients. Early integration of ACP during the illness trajectory and a broader regional approach may be more appropriate.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1136/bmjspcare-2017-001489
- PMID 30665882
- Persistent URL
- https://sonar.ch/global/documents/47479
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