Faculty Collaboration Database

Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis: A Pilot Study. J Pain Symptom Manage 2020 Apr;59(4):864-870

Date

12/28/2019

Pubmed ID

31881290

DOI

10.1016/j.jpainsymman.2019.12.355

Scopus ID

2-s2.0-85078362981 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

BACKGROUND: Despite significant morbidity and mortality among patients with decompensated cirrhosis, reported rates of advance directive (AD) completion and goals of care discussions (GCDs) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention.

MEASURES: Rates of AD and GCD completion, as well as self-reported barriers to ACP.

INTERVENTION: Provider-led ACP in patients with decompensated cirrhosis without a prior documented AD.

OUTCOMES: Sixty-two patients were seen over 115 clinic visits. After the intervention, AD completion rates increased from 8% to 31% and GCD completion rates rose from 0% to 51%. Women (P = 0.048) and nonmarried adults (P = 0.01) had greater changes in AD completion compared to men and married adults, respectively. Needing more time during visits was seen as the major barrier to ACP among providers.

CONCLUSIONS/LESSONS LEARNED: Addressing provider and system-specific barriers dramatically improved documentation rates of ACP.

Author List

Patel A, Kogekar N, Agarwal R, Cohen C, Esteban JP, Pourmand K, Tsai E, Harty A, Pelham-Braithwaite A, Perumalswami P, Dieterich D, Schiano T

Author

James Esteban MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Advance Care Planning
Advance Directives
Female
Humans
Liver Cirrhosis
Male
Outpatients
Pilot Projects