Researchers offer practical steps to ensure clinicians follow patients' advance care plans.
Although patients often have advance planning documents that specify their end-of-life healthcare preferences, it's not always clear whether those plans are being followed.
Researchers from the Regenstrief Institute, the Indiana University Center for Aging Research, and the IU School of Nursing recently published a five-point plan to help clinicians understand and follow patient preferences.
Nearly a quarter of hospitalized older Americans cannot make end-of-life decisions for themselves, according to the researchers.
The five-point plan and a discussion of the challenges and metrics involved were posted on the Journal of Pain and Symptom Management website.
The five recommendations for improving consistency with patient preferences are:
- Document specific treatment preferences in the medical record, such as "do not place feeding tube," instead of simply saying "comfort care."
- Record treatment preferences in a consistent format and location in the patient medical record.
- Review and update patient preferences regularly to reflect current preferences as his or her clinical condition changes over time.
- Implement prospective data collection strategies to capture decisions to withhold interventions.
- Adopt a consistent measurement approach to share process and outcomes data with other healthcare providers.
"Advance care planning is a process, not just a form," co-author Alexia Torke, MD, said in a statement. "It is important that when a person faces serious illness and can no longer make decisions, the care they receive is consistent with the wishes they have previously expressed."
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The authors also discussed the challenges of implementing and measuring the "Care Consistency With Documented Care Preferences" quality indicator. This metric is widely used in hospice and palliative care.
Some of the challenges they encountered were inaccurate or incomplete documentation and patients' preferences changing over time.
"What we choose to measure and how we measure drives how we set up our systems to deliver that care," first author Kathleen Unroe, MD, MHA, said in a statement.
"We need to focus on patient outcomes, not just processes."