End Of Life Wishes Research Articles

Clinician Perspectives on Challenges to Patient Centered Care at the End of Life.

Discussions regarding patient preferences for resuscitation are often delayed and preferences may be neglected, leading to the receipt of unwanted medical care. To better understand barriers to the expression and realization of patients' end of life wishes, a preventive ethics team in one Veterans Affairs Medical Center conducted a survey of physicians, nurses, social workers, and respiratory therapists. Surveys were analyzed through qualitative analysis, using sorting methodologies to identify themes. Analysis revealed barriers to patient wishes being identified and followed, including discomfort conducting end-of-life discussions, difficulty locating patients' preferences in medical records, challenges with expiring do not resuscitate (DNR) orders, and confusion over terminology. Based on these findings, the preventive ethics team proposed new terminology for code status preferences, elimination of the local policy for expiration of DNR orders, and enhanced systems for storing and retrieving patients' end-of-life preferences. Educational efforts were initiated to facilitate implementation of the proposed changes.

Advanced cancer patients' reported wishes at the end of life: a randomized controlled trial.

Conversations about end-of-life (EOL) wishes are challenging for many clinicians. The Go Wish card game (GWG) was developed to facilitate these conversations. Little is known about the type and consistency of EOL wishes using the GWG in advanced cancer patients. We conducted a randomized controlled trial to assess the EOL wishes of 100 patients with advanced cancer treated at The University of Texas MD Anderson Cancer Center. The purpose of this study was to determine the EOL wishes of patients with advanced cancer and to compare patients' preference between the GWG and List of wishes/statements (LOS) containing the same number of items. Patients were randomized into four groups and completed either the GWG or a checklist of 35 LOS and one opened statement found on the GWG cards; patients were asked to categorize these wishes as very, somewhat, or not important. After 4-24h, the patients were asked to complete the same or other test. Group A (n=25) received LOS-LOS, group B (n=25) received GWG-GWG, group C (n=26) received GWG-LOS, and group D (n=24) received LOS-GWG. All patients completed the State-Trait Anxiety Inventory (STAI) for adults before and after the first test. Median age (interquartile range=IQR): 56 (27-83) years. Age, sex, ethnicity, marital status, religion, education, and cancer diagnosis did not differ significantly among the four groups. All patients were able to complete the GWG and/or LOS. The ten most common wishes identified as very important by patients in the first and second test were to be at peace with God (74 vs. 71%); to pray (62 vs. 61%); and to have family present (57 vs. 61%). to be free from pain (54 vs. 60%); not being a burden to my family (48 vs. 49%); to trust my doctor (44 vs. 45%); to keep my sense of humor (41 vs. 45%); to say goodbye to important people in my life (41 vs. 37%); to have my family prepared for my death (40 vs. 49%); and to be able to help others (36 vs. 31%). There was significant association among the frequency of responses of the study groups. Of the 50 patients exposed to both tests, 43 (86%) agreed that the GWG instructions were clear, 45 (90%) agreed that the GWG was easy to understand, 31 (62%) preferred the GWG, 39 (78%) agreed that the GWG did not increase their anxiety and 31 (62%) agreed that having conversations about EOL priorities was beneficial. The median STAI score after GWG was 48 (interquartile range, 39-59) vs. 47 (interquartile range, 27-63) after LOS (p=0.2952). Patients with advanced cancer assigned high importance to spirituality and the presence/relationships of family, and these wishes were consistent over the two tests. The GWG did not worsen anxiety.

End-of-life planning in a rural elderly cohort

Relationships between end-of-life (EOL) planning and demographic and health related variables for individuals living in three rural West Texas counties were examined using a prospective cohort study design. Project FRONTIER, a longitudinal community-based participatory research project, served as the database for this study. Abstracted data from 692 older adults focused on demographic variables, medical conditions, and EOL planning. EOL planning activities included completing a will (39%), a durable power of attorney (32%), advanced directives (14%), talking with family about EOL wishes (31%), and designating a decision maker (55%). The mean EOL Planning Index was 1.6 (SD = 2.58) with higher numbers indicating greater level of planning. Regression findings supported significantly higher levels of EOL planning influenced by age, education, non-Hispanic ethnicity, chronic disease, depression, and communication with family about nursing home placement. Aging rural adults and their healthcare providers would benefit from learning more about EOL planning.

HCP-23PROSPECTIVE ASSESSMENT OF CAREGIVER PERCEPTIONS OF END-OF-LIFE CARE IN PATIENTS WITH HIGH GRADE GLIOMA

BACKGROUND: Little is known about the quality of life experienced by patients and caregivers in the end-of-life (EoL) stage of patients with high grade glioma (HGG). The goal of this study is to understand caregiver perceptions of EoL of HGG patients in the final 30 days. METHODS: A prospective observational study for patients with HGG and their caregivers was performed. Caregivers were called every 2 weeks during EoL phase and one month after death to participate in the Toolkit After-Death Bereaved Family Member Interview, part of the Toolkit of Instruments to Measure End-of-Life Care (TIME survey). RESULTS: 25 out of 30 caregivers completed the TIME interview. All patients were followed by hospice at time of death. Twenty-one patients (84%) died at home, 2 (8%) at an inpatient hospice and 2(8%) at a facility. Thirteen patients (52%) had a durable power of attorney but only 2(8%) had a living will. Twenty-one patients (84%) lost consciousness prior to death at a median of 4 days (range 1-7). Overall from hospice was well perceived well and measured with 5 questions, using a Likert scale (0-10, 10 the best): communication (8.6±1.44), respected wishes (9.4±1.12), symptoms controlled (8.8±1.63), died with dignity (9.6±1.08), providing emotional support (8.2±1.61), best possible (8.7±1.22). Based on Time survey domain scores, caregivers felt that care coordination and informing and decision making were handled well while advanced planning, focus on individual and to family could be slightly improved. CONCLUSIONS: Caregivers were overall satisfied with the EoL received by patients. Only about half of all patients had a power of attorney in place and 8% had documented their EoL wishes. Earlier palliative interventions might help to better direct end of life wishes and to improve attention to caregiver needs.

Advanced cancer patients' priorities regarding wishes at the end of life: A randomized controlled study.

44 Background: Conversations about wishes around the end-of-life(EOL) are challenging for clinicians. There is limited literature about the type and stability of patient’s reported EOL planning priorities. We compared a set of 36 cards (“Go-wish-Game”: GWG) v. a paper list of statements (LOS) to assist patients in establishing priorities. Methods: Randomized controlled study. Pts. were randomized to the GWG or to 36 LOS and were asked to categorize them as very, somewhat, or not important; Group A received LOS followed by LOS 4-24 hours later; group B: GWG-GWG; group C: GWG-LOS, and group D: LOS-GWG. The State-Trait Anxiety inventory for Adults(STAI) was done after the first set of questionnaires. Results: 100 pts. Median age (IQR): 56 (27-83) years. 60% female. 68% White, 17% Hispanic, and 9% African-American. 62% married. Age, marital status, religion, education and cancer diagnosis were not significant different among groups. All pts. were able to complete the GWG. 43/50 (88%) agreed that instructions of GWG were clear. 45/50 (92%) agreed that GWG was easy to understand. 31/50 (64%) patients exposed to both tools, preferred GWG. 39/50 (79%) expressed that GWG did not increased their anxiety. 31/50 (63%) expressed that having conversations about priorities near EOL is beneficial to them (p=NS). STAI median (IQR) score after GWG was 48 (39-59) v. 47 (27-63) for LOS, p=0.2952. The 10 most common “Very important” wishes expressed by pts. the first and second time they received the test (%; Spearman, p-value) were: to be at peace with God(74% v. 71%; r=0.73, p<0.0001), to pray(62% v. 61%, r=0.53, p<0.0001), to have my family with me(57% v. 61%; r=0.23, p=0.02), to be free from pain(54% v. 60%, r=0.31, p=0.001), not being a burden to my family(48% v. 49%, r=0.23, p=0.02), to trust my doctor(44% v. 45%; r=0.49, p<0.0001), to keep my sense of humor(41% v. 45%; r=0.53, p<0.0001), to say goodbye to important people in my life(41% v. 37%; r=0.46, p<0.0001); to have my family prepared for my death(40% v. 49%; r=0.48, p<0.0001). Conclusions: EOL wishes were similar and persistent using both GWG and LOS. Completing both GWG and LOS did not increase anxiety. All patients were able to complete and most preferred GWG.

PA20 Views on talking about death, dying and loss.

Societal barriers to open discussion of personal feelings and preferences relating to death may hinder planning for end of life and supporting people who are dying or bereaved. To explore views about talking about death, dying and loss. Semi-structured interviews were conducted with 31 people; age range 30 to 83 years. Making wills and communicating end of life wishes were considered very important; mostly for the sake of the family left behind. Participants also valued confidence to discuss other people's end of life wishes and support them appropriately if they were dying or bereaved. Many participants were very comfortable talking about their own death. Identified barrier to talking about end of life wishes included not wanting to upset others; others not listening; not being about to find an appropriate moment; not knowing enough about the options available; and fear of death, especially of the unknown. Financial costs were seen as a barrier to making a will. Participants talked of the importance of raising awareness of what death and dying involves; what end of life options available; and the importance of communication. Information on the process of normal grieving and how to support somebody who has been bereaved were also suggested. Being able to talk about end of life wishes and know how to support people who are dying or bereaved are important to many people, and they would welcome interventions to facilitate this at a societal level.

Abstracts from theCenter to Advance Palliative Care National Seminar Pathways to Quality Palliative CareNovember 13–15, 2014Orlando, Florida

Abstracts from theCenter to Advance Palliative Care National Seminar Pathways to Quality Palliative Care<i>November 13–15, 2014</i><i>Orlando, Florida</i>

PA17 Interventions to improve upstream communication about death and dying.

Death is universal. Only 37% of adults have a will and 48% have stated their wishes regarding cremation or burial.(1) Planning and communication can help prevent some of the distress associated with dying and bereavement. To evaluate an intervention to encourage people to plan for the end of their life and to communicate their wishes to those closest to them. Two interventions were delivered via community groups: 'Awareness' presentations aimed to raise awareness of benefits of preparing and talking about end of life issues. 'How to' workshops aimed to give people confidence and tools to open relevant conversations. To evaluate their impact, we conducted a 3-stage questionnaire survey; administered before, immediate after and 3 months after events. At baseline (n = 498; 76% female) 76% had previously discussed end of life care or wishes after death. Most were comfortable talking about these subjects, giving a mean score of 8.28/10. At follow-up (n = 133); 60% indicated they had made changes following the event; 43% had talked about their own end of life wishes, 9% for the first time; and 39% reported making other changes. The change in the proportion of people who had ever talked about their own end of life wishes was statistically significant (p = 0.033). Well designed community events can improve planning and communication of end of life preferences among general population. Dying Matters Survey http://www.comres.co.uk/polls/Dying_Matters_Public_April12.pdf.

WA30 The dying well community charter and dying matters: a united kingdom (uk) approach to public health and dying.

The Dying Matters Coalition, set up following the UK Government's End of Life Care Strategy in 2008, is led by the NCPC (UK umbrella organisation). Dying Matters supports changing knowledge, attitudes and behaviours towards dying, death and bereavement, and through this to make 'living and dying well' the norm. The Coalition has over 30,000 members, and encourages people to talk to friends and family about their end of life wishes, including how they would like to be cared for, where they want to die and their funeral plans. The Dying Well Community Charter is an innovative approach to community development work, working with Pathfinder areas to pilot this approach, rather than encouraging health and social care services to "do" end of life care "to" people, to encourage them to work with community leaders to make end of life care everyone's responsibility. Participants will discover what has worked in the UK, including many low resource options, and a community development approach to palliative care. We worked with 8 Pathfinder communities to ask them to pilot the Dying Well Community Charter approach. Dying Matters was the first national awareness and behaviour change campaign around death, dying and bereavement. Dying Matters has over 30,000 members. Outcome of the Charter work is unknown, but more will be known by the time of the conference. How communities can come together for better death, dying and bereavement. That death and dying are not subjects that need to be avoided, and can be engaged with for better outcomes.

"Allow Natural Death" versus "Do Not Resuscitate": What Do Patients with Advanced Cancer Choose?

Many patients with advanced cancer at our hospital request full resuscitative efforts at the end of life. We assessed the knowledge and attitudes of these patients towards end-of-life (EOL) care, and their preferences about "Do Not Resuscitate" (DNR), "Allow Natural Death" (AND), and "full code" orders. The first 100 consenting adult patients with advanced cancer were surveyed regarding their diagnosis, prognosis, and attitudes about critical care and resuscitation. They were then presented with hypothetical scenarios in which a decision on their code status had to be made if they had one year, six months, or one month left to live. Half were given a choice between being "full code" and "DNR," and half could choose between "full code" and "AND." All 93 of the participants who completed the survey were considered by their attending physician to have a terminal illness, but only 42% of these interviewees believed they were terminally ill. In addition, only 25% of participants thought that their primary oncologist knew their EOL wishes. Participants were equally likely to choose either of the "no code" options in all hypothetical scenarios (p>0.54), regardless of age, sex, race, type of cancer, education, or income level. A similar proportion of patients who had a living will chose "AND" and "DNR" orders instead of "full code" in all the scenarios (47%-74% and 63%-71%). In contrast, among patients who did not have a living will, 52% chose "DNR," while 19% opted for "AND." We hypothesized that "AND" orders may be more acceptable to patients with advanced cancer, but there was no statistically significant difference in acceptability between "AND" and "DNR" orders.

“It's About the Conversation”: A Multidisciplinary Intervention to Support Advance Care Planning (S808)

•Understand how the “Go Wish” card game is played.•Describe how various forms of media can be used to advertise and effectively engage patients, caregivers, and staff. A recent California Healthcare Foundation study found 60% of Californians highly valued “making sure their families are not burdened by tough decisions about their care.” However, less than 50% have communicated end-of-life (EOL) wishes to their surrogate decision maker. 82% say it is important to have EOL wishes in writing, but only 23% say they have done so. At City of Hope (COH), the advance directive (AD) completion rate is less than 15%. The event should engage patients and staff in advance care planning (ACP) conversations and increase AD completion. A multi-disciplinary team designed a social media advertised 4-hour interactive event. Over 40 staff and volunteers facilitated individualized ACP conversations, private consultations with social workers, showed novel COH ACP videos, provided multi-lingual ACP literature and AD documents available for completion with complimentary notary support on-site. Over 300 people attended. 47 ADs were completed (24 by patient/caregivers, 23 by COH staff). 29 Go Wish games were facilitated (2 in Spanish). Of 52 attendees who completed exit evaluations, 44% were patients, 31% staff, and 11% were caregivers. Respondents reported the event increased their comfort and likelihood of having ACP conversations with others. Importantly, 38 of the 52 surveyed did not have an AD prior to attending the event. Of those 38 attendees, 18 of them completed an AD at the event (or 47%). ACP is an all too often avoided conversation that results in increased distress of patients, families, and providers. By proactively designing opportunities for facilitated conversations in dynamic and public arenas, fear and stigmas are diffused and the true focus and intent of discovering what people wish so the medical team, surrogates, and family can ensure their values are honored and met.

The Evolving Role of Palliative Care in the Trauma Patient (TH304)

Objectives Describe SCAN’s Program for Advanced Illness. Discuss how SCAN is using palliative care to improve quality of care and patient satisfaction. Describe measured outcomes for the first year of an advanced illness management program. SCAN Health Plan is a Medicare Advantage Plan in California and Arizona serving 170,000 members. In 2013, SCAN launched a case management program to assist members with multiple chronic health conditions manage their symptoms and medications. The Program for Advanced Illness (PAI) is designed to manage the sickest patients in the last months and years of life. The goals of the program are to better manage symptoms, improve member and family/ caregiver satisfaction, and improve overall quality of care, while reducing inpatient/ER utilization. PAI is one of several case management programs provided by SCAN to its members. Other programs include Complex Care Management, Memory Program, Care Transitions, and Disease Management. The PAI program provides telephonic case management for members at any stage of an advanced illness. The approach is patient centered and holistic and incorporates psychosocial, cultural, and spiritual aspects of care. Registered nurses provide the telephonic case management to members and are supported by an interdisciplinary team of social workers, geriatricians, chaplains, and palliative care physicians. Activities of the program include education about goals of care and documentation of goals, coaching of members and families about how to discuss endof-life wishes with providers, facilitation of discussion of members’ wishes, pain and symptom management, identifying resources for care, and education about POLST and advanced healthcare directives. We will present SCAN’s program in detail. We will discuss the training of the RN case managers using a board-certified palliative care physician who provides training and ongoing support. Outcome measures for the first year of the program will be presented. These metrics include increased length of stay in hospice, member wishes followed at end of life, death in place of preference, decreased hospitalization, decreased ICU utilization, and member/caregiver satisfaction. The Evolving Role of Palliative Care in the Trauma Patient (TH304) Alan Roth, DO, Jamaica Hospital Medical Center, Jamaica, NY. Angelo Canedo Jamaica Hospital Medical Center, Jamaica, NY.

Discussing End of Life Care: An Opportunity

Most deaths now occur in medical or skilled nursing settings. This brings speech-language pathologists, and other professionals, in close contact with clients who face death. While it can feel uncomfortable, speech-language pathologists are in a position to influence this phase of their client's quality-of-life life by addressing death and end of life wishes. This can be a goal of therapy.

Advance care planning among seniors of a diverse city.

117 Background: Advance care planning (ACP) is a system of education, reflection and documentation of health care wishes. Respecting Choices has been successful in implementing ACP throughout Lacrosse County, WI (J Am Geriatr Soc 2010;58:1249–1255)..A single center study in Melbourne, AU, showed that ACP improves end of life (EOL) care, patient and family satisfaction, and reduces stress, anxiety, and depression in surviving relatives (BMJ 2010;340:c1345).We aim to quantify knowledge about ACP, interest in engaging in ACP, and barriers to effective ACP among the older adults of Chicago. The results will provide actionable items to implement an ACP program in a diverse city. Methods: 17 of the 22 City of Chicago senior centers participated in a survey and education forum “Starting the Conversation”. Participants provided demographic information, awareness and knowledge of EOL wishes and advance directives (AD). Data was tabulated and analyzed using descriptive statistics in IBM SPSS Statistics 22 Software. Results: 375 people completed the survey, the average age was 70+8, (range 41 to 93), 93.3% in English, and 6.7% in Spanish. Respondents live alone (44.5%), with a spouse (29.9%) or child (14.4%). 71% have thought about the medical care they would want at the EOL, 60% have discussed their EOL wishes with their loved ones, and 4% with their doctor. 60.5% do not know what an AD is, 25% have an AD, 76% know who would speak for them if they were unable, 58% have discussed their wishes with that person. Using neighborhood demographics, there was no difference in having an AD for predominately African American neighborhoods compared to others (33% and 27%). Respondents from lower income neighborhoods were less likely to think about medical care at the EOL (65% and 77%), less likely to have discussed EOL care (41% and 30% have not discussed EOL care) and less likely to have an AD (19% and 31%). Conclusions: ACP is underutilized in Chicago. The frequency of AD completion among Chicago seniors mirrors that of the US (Am J Public Health. 2013;103(6):e8-e10). Unlike other population studies, no difference was found among racial groups. Participants are aware of EOL wishes, are interested in engaging in these conversations, but lack the knowledge and collaboration of their healthcare team.

Abstract 352: Clinician Attitudes and Self-Reported Practices Regarding End of Life Care in Heart Failure

Background: Heart failure (HF) is a clinical syndrome with an overall poor prognosis, but the clinical trajectory is often unpredictable in individuals. There has been an impetus to promote iterative patient-provider discussions regarding preferences for end of life (EOL) care and advanced care planning. However, very little is known regarding provider preferences or their personal confidence addressing EOL care with their patients with HF. To address these gaps in knowledge, we surveyed clinicians at three practice sites in a large integrated health system. Methods: Physicians, nurse practitioners (NP), and physician assistants (PA) at Mayo Clinic (Rochester, Minnesota) and its surrounding health system were asked to participate in an electronic survey in October 2013. Clinicians surveyed included tertiary care HF specialists (Tertiary Care Cardiology), cardiologists and NP/PAs practicing in a community setting (Community Cardiology), and primary care clinicians (Primary Care). Results: A total of 95 clinicians completed the survey (52.5% response rate), including 50 physicians and 45 NP/PAs. Clinicians reported discussing prognosis and EOL wishes when their patient’s health status was worsening, but only 12% reported annual discussions as advocated by the American Heart Association. In total 52% of providers reported one or more reasons that they hesitate to discuss EOL care with their patients, including provider discomfort (11%), perception of patient (21%) or family (12%) unreadiness to have the discussion, fear of destroying hope (9%), or a lack of time (8%). Tertiary Care (63%) and Community Cardiology (58%) clinicians were more likely to attribute responsibility for having EOL discussions to the HF cardiologist, while 66% of Primary Care providers felt it was their responsibility. Tertiary and Community Cardiology clinicians were more likely to have referred patients to Palliative Medicine within the last year than Primary Care (89% vs. 21%, p&lt;0.001). Overall, 30% of those surveyed reported low or very low confidence levels in initiating prognosis or EOL discussions, enrolling patients in hospice, or providing EOL care, with lower confidence among those with fewer years of clinical experience. The majority of clinicians expressed a high level of interest in further skills acquisition on these topics. Conclusion: There is tremendous variability in the way that clinicians view and approach advanced care discussions with their patients with HF; varying provider perception and lack of provider confidence may contribute. Despite this variability, most clinicians are interested in further development and skills acquisition. Addressing the learning needs of providers is an important next step toward enhancing the EOL care of patients with HF.

An Exploratory Survey of End-of-Life Attitudes, Beliefs, and Experiences of Adolescents With HIV/AIDS and Their Families

ContextFor youths with life-limiting conditions, little is known regarding families' understanding of their adolescent's wishes for end-of-life (EOL) care. ObjectivesTo examine congruence in HIV positive adolescents and their families' thoughts about death and dying. MethodsThe Lyon Advance Care Planning Survey-Adolescent and Surrogate versions were administered within a randomized controlled trial. Participants (n=48) were medically stable adolescents aged 14–21 years with HIV/AIDS and their families. Congruence was measured by intraclass correlation coefficients (ICCs) for continuous variables and by kappa for ordinal or dichotomous responses. ResultsAdolescent participants were as follows: mean age 16.6 years (range 14–21); 37.5% males; 92% African American; 38% CD4 count <200; and viral load mean=32,079 copies/mL (range <400–91,863 copies/mL). Adolescent/family dyads agreed that it is important to complete an advance directive to let loved ones know their wishes (21/24 dyads), yet no dyads agreed an advance directive had been completed. Dyads endorsed incongruent thoughts about the adolescent being afraid of dying in pain (64%; congruent afraid=8 dyads, kappa=−0.0769) and being off life support machines (congruent important=9 dyads, ICC=−0.133, 95% confidence interval = −0.540, 0.302, P=0.721). Families' knowledge of teens' preferences for the timing of EOL conversations (early vs. late in course of illness) was poor (kappa=−0.1186). Adolescents (90%) wanted to talk about EOL issues before they entered the dying phase. ConclusionAlthough important areas of congruence emerged, equally important areas, such as the timing of these conversations and adolescents' EOL needs and wishes, are not known by their families. Families need help initiating conversations to assure that their adolescents' EOL wishes are known to them.

Lifetime traumas and their influence on advanced cancer patients’ illness understanding and likelihood of end-of-life discussions.

9146 Background: Research on posttraumatic stress in cancer patients has focused on patient reactions to their cancer diagnosis. Few studies have examined the impact of lifetime traumatic events prior to diagnosis on how advanced cancer patients understand the life-threatening nature of their illness and how likely they are to discuss their end-of-life (EOL) wishes with their oncology providers. Methods: The Coping with Cancer (CwC) is an NCI-funded prospective, multi-institutional cohort study of advanced cancer patients and their caregivers. Participants were recruited from September 2002 to February 2008 from six comprehensive cancer centers across the United States. Lifetime traumas were captured by the number of events reported in response to the Structured Clinical Interview for the DSM-IV (SCID) Lifetime Posttraumatic Stress Disorder question that probed for “extremely upsetting” life events. Associations between patient characteristics and number of lifetime traumas were estimated as odds ratios using ordinal logistic regression. Associations between number of lifetime traumatic exposures, controlling for confounding patient characteristics, and patient Terminal Illness Acknowledgement (TIA) and reports of EOL discussions were estimated as odds ratios using multiple logistic regression. Results: After adjusting for race, education, and recruitment site, the number of lifetime traumas patients reported remained significantly associated with TIA (OR = 1.25, p = .034) and discussion of EOL wishes (OR = 1.29, p = .013). Conclusions: The greater the number of traumatic experiences reported by cancer patients the more likely they are to acknowledge that they are terminally ill and discuss their end-of-life wishes with their oncology providers. The impact of witnessing or experiencing serious or life-threatening events in the past appears to improve advanced cancer patients’ abilities to understand the seriousness of their condition and increases the likelihood that they will discuss their preferences for care at the end of life with their doctors.

Structured advance care planning and its impact on patients at end-of-life: a review

IntroductionFollowing the trial conducted by Detering et al (2008), Respecting Patient Choices implemented a formal process for advance care planning (ACP) provided by dedicated ACP staff. The intention was to...

When do patients hospitalized for heart failure want to communicate?

Purpose: The aims of this study were to 1) identify when heart failure (HF) patients want to communicate regarding disease management, prognosis and end of life wishes, and 2) to identify the relationship of communication with clinical variables and quality of life (QOL).

The impact of advance care planning on end of life care in elderly patients: randomised controlled trial

Objective To investigate the impact of advance care planning on end of life care in elderly patients.Design Prospective randomised controlled trial.Setting Single centre study in a university hospital in Melbourne,...