Who Should Discuss Advance Care Planning? A Survey of Preferences Among Hospitalized Patients with Serious Illness (SA518B)

Abstract

•Define a population of non-oncology patients with serious illness using disease specific criteria.•Identify with whom non-oncology hospitalized patients with serious illness prefer to have advance care planning conversations.•Apply this data to educate outpatient physicians about the importance of advance care planning conversations. Advance care planning (ACP) is the process whereby patients articulate their preferences regarding medical care at the end of life. For the seriously ill, ACP is a priority; however it is unclear with which provider patients prefer to have those conversations. 1.To determine with which provider seriously ill, hospitalized, non-oncology patients prefer to have ACP conversations. 2. To identify factors associated with a patient’s provider preference. Investigators developed a survey to assess patients’ preferences, adapting items from a prior instrument.1 In conjunction with disease experts, investigators developed criteria to define ‘seriously ill’ inpatients with common non-oncologic diseases (CHF, ESRD, COPD, and cirrhosis). Patients were eligible if they met ‘seriously ill’ criteria and/or one year mortality was high as determined by the ‘Surprise Question.’ Patients on the medicine inpatient services at an academic hospital were surveyed. A total of 54 of 69 approached patients consented to participate. The majority (94%) (95% CI 89-100%) thought ACP was important; a minority (38%) [95% CI 25-53%] discussed ACP with a doctor before hospitalization; 14% [95% CI 6-26%] had an ACP conversation with a doctor during the index hospitalization. Most (85%) [95% CI 72-93%] prefer to discuss ACP with an outpatient provider (66% primary care physician (PCP), 19% outpatient specialist). Age, gender, frequency of outpatient visits and inpatient hospitalizations were not associated with physician preference. Longer duration and increased strength of the relationship were associated with preference for PCP (p=0.08 and p = <0.0001, respectively). Seriously ill, hospitalized non-oncology patients prefer to have ACP conversations with outpatient physicians, most commonly their PCP. Longer and stronger relationships are associated with PCP preference.