Predictors of Advance Care Planning Documentation in Patients With Underlying Chronic Illness Who Died of Traumatic Injury
Advance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with increasing numbers of trauma victims being elderly or having multimorbidity. Identify predictors of absent ACP documentation in the electronic health rec...
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| Vydané v: | Journal of pain and symptom management Ročník 58; číslo 5; s. 857 - 863.e1 |
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| Médium: | Journal Article |
| Jazyk: | English |
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United States
Elsevier Inc
01.11.2019
Elsevier Limited |
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| ISSN: | 0885-3924, 1873-6513, 1873-6513 |
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| Abstract | Advance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with increasing numbers of trauma victims being elderly or having multimorbidity.
Identify predictors of absent ACP documentation in the electronic health records of patients with underlying chronic illness who died of traumatic injury.
We used death records and electronic health records to identify decedents with chronic life-limiting illness who died of traumatic injury between 2010 and 2015 and to evaluate factors associated with documentation of living wills, durable powers of attorney, or physician orders for life-sustaining treatment.
Only 22% of decedents had ACP documentation at time of injury. Among those without preinjury ACP documentation, 4% completed ACP documentation after injury. In multipredictor analyses, patients were less likely to have ACP documentation at the time of injury if they were younger (P < 0.001), had fewer chronic illnesses (P = 0.002), and had fewer nonsurgical hospitalizations (P = 0.042) in the year before injury. Among patients without ACP documentation before injury, those with fewer postinjury nonsurgical hospitalizations were less likely to complete ACP documentation after injury (P = 0.019).
Our findings suggest that patient characteristics play an important role in the completion of ACP among patients with chronic life-limiting illness and who died from sudden severe injury. Interventions to improve ACP completion by patients with serious chronic conditions have the potential for increasing goal-concordant care in the event of traumatic injury. |
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| AbstractList | Advance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with increasing numbers of trauma victims being elderly or having multimorbidity.CONTEXTAdvance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with increasing numbers of trauma victims being elderly or having multimorbidity.Identify predictors of absent ACP documentation in the electronic health records of patients with underlying chronic illness who died of traumatic injury.OBJECTIVESIdentify predictors of absent ACP documentation in the electronic health records of patients with underlying chronic illness who died of traumatic injury.We used death records and electronic health records to identify decedents with chronic life-limiting illness who died of traumatic injury between 2010 and 2015 and to evaluate factors associated with documentation of living wills, durable powers of attorney, or physician orders for life-sustaining treatment.METHODSWe used death records and electronic health records to identify decedents with chronic life-limiting illness who died of traumatic injury between 2010 and 2015 and to evaluate factors associated with documentation of living wills, durable powers of attorney, or physician orders for life-sustaining treatment.Only 22% of decedents had ACP documentation at time of injury. Among those without preinjury ACP documentation, 4% completed ACP documentation after injury. In multipredictor analyses, patients were less likely to have ACP documentation at the time of injury if they were younger (P < 0.001), had fewer chronic illnesses (P = 0.002), and had fewer nonsurgical hospitalizations (P = 0.042) in the year before injury. Among patients without ACP documentation before injury, those with fewer postinjury nonsurgical hospitalizations were less likely to complete ACP documentation after injury (P = 0.019).RESULTSOnly 22% of decedents had ACP documentation at time of injury. Among those without preinjury ACP documentation, 4% completed ACP documentation after injury. In multipredictor analyses, patients were less likely to have ACP documentation at the time of injury if they were younger (P < 0.001), had fewer chronic illnesses (P = 0.002), and had fewer nonsurgical hospitalizations (P = 0.042) in the year before injury. Among patients without ACP documentation before injury, those with fewer postinjury nonsurgical hospitalizations were less likely to complete ACP documentation after injury (P = 0.019).Our findings suggest that patient characteristics play an important role in the completion of ACP among patients with chronic life-limiting illness and who died from sudden severe injury. Interventions to improve ACP completion by patients with serious chronic conditions have the potential for increasing goal-concordant care in the event of traumatic injury.CONCLUSIONSOur findings suggest that patient characteristics play an important role in the completion of ACP among patients with chronic life-limiting illness and who died from sudden severe injury. Interventions to improve ACP completion by patients with serious chronic conditions have the potential for increasing goal-concordant care in the event of traumatic injury. Advance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with increasing numbers of trauma victims being elderly or having multimorbidity. Identify predictors of absent ACP documentation in the electronic health records of patients with underlying chronic illness who died of traumatic injury. We used death records and electronic health records to identify decedents with chronic life-limiting illness who died of traumatic injury between 2010 and 2015 and to evaluate factors associated with documentation of living wills, durable powers of attorney, or physician orders for life-sustaining treatment. Only 22% of decedents had ACP documentation at time of injury. Among those without preinjury ACP documentation, 4% completed ACP documentation after injury. In multipredictor analyses, patients were less likely to have ACP documentation at the time of injury if they were younger (P < 0.001), had fewer chronic illnesses (P = 0.002), and had fewer nonsurgical hospitalizations (P = 0.042) in the year before injury. Among patients without ACP documentation before injury, those with fewer postinjury nonsurgical hospitalizations were less likely to complete ACP documentation after injury (P = 0.019). Our findings suggest that patient characteristics play an important role in the completion of ACP among patients with chronic life-limiting illness and who died from sudden severe injury. Interventions to improve ACP completion by patients with serious chronic conditions have the potential for increasing goal-concordant care in the event of traumatic injury. Context. Advance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with increasing numbers of trauma victims being elderly or having multimorbidity. Objectives. Identify predictors of absent ACP documentation in the electronic health records of patients with underlying chronic illness who died of traumatic injury. Methods. We used death records and electronic health records to identify decedents with chronic life-limiting illness who died of traumatic injury between 2010 and 2015 and to evaluate factors associated with documentation of living wills, durable powers of attorney, or physician orders for life-sustaining treatment. Results. Only 22% of decedents had ACP documentation at time of injury. Among those without preinjury ACP documentation, 4% completed ACP documentation after injury. In multipredictor analyses, patients were less likely to have ACP documentation at the time of injury if they were younger (P < 0.001), had fewer chronic illnesses (P = 0.002), and had fewer nonsurgical hospitalizations (P = 0.042) in the year before injury. Among patients without ACP documentation before injury, those with fewer postinjury nonsurgical hospitalizations were less likely to complete ACP documentation after injury (P = 0.019). Conclusions. Our findings suggest that patient characteristics play an important role in the completion of ACP among patients with chronic life-limiting illness and who died from sudden severe injury. Interventions to improve ACP completion by patients with serious chronic conditions have the potential for increasing goal-concordant care in the event of traumatic injury. AbstractContextAdvance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with increasing numbers of trauma victims being elderly or having multimorbidity. ObjectivesIdentify predictors of absent ACP documentation in the electronic health records of patients with underlying chronic illness who died of traumatic injury. MethodsWe used death records and electronic health records to identify decedents with chronic life-limiting illness who died of traumatic injury between 2010 and 2015 and to evaluate factors associated with documentation of living wills, durable powers of attorney, or physician orders for life-sustaining treatment. ResultsOnly 22% of decedents had ACP documentation at time of injury. Among those without preinjury ACP documentation, 4% completed ACP documentation after injury. In multipredictor analyses, patients were less likely to have ACP documentation at the time of injury if they were younger ( P < 0.001), had fewer chronic illnesses ( P = 0.002), and had fewer nonsurgical hospitalizations ( P = 0.042) in the year before injury. Among patients without ACP documentation before injury, those with fewer postinjury nonsurgical hospitalizations were less likely to complete ACP documentation after injury ( P = 0.019). ConclusionsOur findings suggest that patient characteristics play an important role in the completion of ACP among patients with chronic life-limiting illness and who died from sudden severe injury. Interventions to improve ACP completion by patients with serious chronic conditions have the potential for increasing goal-concordant care in the event of traumatic injury. |
| Author | Engelberg, Ruth A. Curtis, J. Randall Lee, Robert Y. Powelson, Elisabeth Sibley, James Lober, William B. Khandelwal, Nita Downey, Lois Kim, Justin |
| Author_xml | – sequence: 1 givenname: Justin surname: Kim fullname: Kim, Justin organization: Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, New York, New York, USA – sequence: 2 givenname: Ruth A. surname: Engelberg fullname: Engelberg, Ruth A. organization: Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA – sequence: 3 givenname: Lois surname: Downey fullname: Downey, Lois organization: Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA – sequence: 4 givenname: Robert Y. orcidid: 0000-0001-5535-287X surname: Lee fullname: Lee, Robert Y. organization: Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA – sequence: 5 givenname: Elisabeth surname: Powelson fullname: Powelson, Elisabeth organization: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA – sequence: 6 givenname: James surname: Sibley fullname: Sibley, James organization: Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA – sequence: 7 givenname: William B. orcidid: 0000-0002-1053-7501 surname: Lober fullname: Lober, William B. organization: Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA – sequence: 8 givenname: J. Randall surname: Curtis fullname: Curtis, J. Randall organization: Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA – sequence: 9 givenname: Nita surname: Khandelwal fullname: Khandelwal, Nita email: khandel@uw.edu organization: Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA |
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| Cites_doi | 10.1136/ip.2005.009076 10.1056/NEJMsa0907901 10.1016/j.surg.2011.07.065 10.1136/bmj.c1345 10.1017/S1478951510000064 10.1371/journal.pone.0193019 10.1016/j.amjsurg.2015.04.007 10.1186/s13049-015-0094-2 10.1097/TA.0b013e31824d0e57 10.1097/01.NJH.0000319173.58467.03 10.1016/j.jamcollsurg.2009.03.015 10.1097/TA.0000000000002000 10.1016/j.amjsurg.2012.02.014 |
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| Snippet | Advance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with increasing... AbstractContextAdvance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially... Context. Advance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with... |
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| SubjectTerms | Advance care planning Advance directives Anesthesia Archives & records Care plans chronic illness Chronic illnesses Computerized medical records Documentation Electronic health records Health records Injuries injury Life Life sustaining treatment Life threatening sickness Living wills Medical records Older people Pain Medicine Patients Physicians Right to die Trauma Traumatic life events Victims Wills |
| Title | Predictors of Advance Care Planning Documentation in Patients With Underlying Chronic Illness Who Died of Traumatic Injury |
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