Abstract
CONTEXTFor many patients, end-of-life care (EOLC) wishes are unknown and are generally only brought up during healthcare crises. During such healthcare episodes, loved ones are often distraught, and as such, can find it difficult to focus on details surrounding the event. The best place for these discussions may be in non-acute settings including primary care clinics. The purpose of this study was to examine how well a sample of patients (N = 177) in three Michigan-based primary care teaching clinics thought they and their loved ones were prepared in terms of having their EOLC wishes known.METHODSProspective data were collected from three Internal Medicine teaching clinics in the Metro-Detroit area through an anonymous written survey addressing EOLC issues in a 16-item cross-sectional study. Respondents were adult patients at one of three participating primary care clinics. Perceived preparedness for EOLC was measured by: 1) possibly having had a prior EOLC discussion with a healthcare provider 2) having created an Advance Directive, such as a Durable Power of Attorney (DPOA) or Living Will with medical decision preferences, 3) reported preferences for quality versus quantity of life, and 4) preferences for CPR and other specific life-sustaining interventions.RESULTSIn this sample, 77 (43.5%) of 177 respondents had discussed their EOLC wishes with a provider. Regarding Advance Directives, 63/177 (35.6%) had established a DPOA, and 59/177 (22%) had made a Living Will. The majority of respondents preferred quality over quantity of life. The most difficult EOLC questions included the decision for CPR, tracheostomy, and PEG tube placement.CONCLUSIONSBased on these results, EOLC discussions probably occur infrequently in the primary care or other healthcare settings. Most survey responses indicated that sample patients were unprepared concerning the details of future EOLC decisions. Engagement of such discussions should be a part of routine visits in the primary care clinic and should be re-visited when there is a change in a patient’s health. Further larger-scale studies using validated surveys are required in this vitally important area of practice. Key Words: advance care planning, end-of-life care conversations, primary care
Highlights
Every person’s life will eventually end, we frequently fail to consider our end of life wishes until faced with a healthcare crisis
Topics of death and dying may be rarely discussed with healthcare providers and considered taboo.[1,2]
Patient’s loved ones often feel burdened making end-of-life decisions, and it can be difficult for healthcare providers to discuss end-of-life-care (EOLC) goals under rushed conditions.[3,4,5]
Summary
Every person’s life will eventually end, we frequently fail to consider our end of life wishes until faced with a healthcare crisis. Topics of death and dying may be rarely discussed with healthcare providers and considered taboo.[1,2] In a report by Hamel et al, 69% of Americans stated that death is a subject people generally avoid discussing.[1] In addition, patient’s loved ones often feel burdened making end-of-life decisions, and it can be difficult for healthcare providers to discuss end-of-life-care (EOLC) goals under rushed conditions.[3,4,5] As such, the best setting for EOLC discussions may be in non-acute settings, like primary care clinics.[4,5]. 92% of people in the United States feel that
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