Initial Experience with "Honoring Choices Wisconsin": Implementation of an Advance Care Planning Pilot in a Tertiary Care Setting. J Palliat Med 2017 Sep;20(9):998-1003
Date
03/30/2017Pubmed ID
28350476Pubmed Central ID
PMC6016723DOI
10.1089/jpm.2016.0530Scopus ID
2-s2.0-85033776451 (requires institutional sign-in at Scopus site) 11 CitationsAbstract
BACKGROUND: Although previous research on advance care planning (ACP) has associated ACP with improved quality of care at the end of life, the appropriate use of ACP remains limited.
OBJECTIVE: To evaluate the impact of a pilot program using the "Honoring Choices Wisconsin" (HCW) model for ACP in a tertiary care setting, and to understand barriers to system-wide implementation.
DESIGN: Retrospective review of prospectively collected data.
SETTING/SUBJECTS: Patients who received medical or surgical oncology care at Froedtert and the Medical College of Wisconsin.
MEASUREMENTS: Patient demographics, disease characteristics, patient satisfaction, and clinical outcomes.
RESULTS: Data from 69 patients who died following the implementation of the HCW program were reviewed; 24 patients were enrolled in the HCW program while 45 were not. Patients enrolled in HCW were proportionally less likely to be admitted to the ICU (12.5% vs. 17.8%) and were more likely to be "do not resuscitate" (87.5% vs. 80.0%), as well as have a completed ACP (83.3% vs. 79.1%). Furthermore, admission to a hospice was also higher among patients who were enrolled in the HCW program (79.2% vs. 25.6%), with patients enrolled in HCW more likely to die in hospice (70.8% vs. 53.3%). The HCW program was favorably viewed by patients, patient caregivers, and healthcare providers.
CONCLUSIONS: Implementation of a facilitator-based ACP care model was associated with fewer ICU admissions, and a higher use of hospice care. System-level changes are required to overcome barriers to ACP that limit patients from receiving end-of-life care in accordance with their preferences.
Author List
Peltier WL, Gani F, Blissitt J, Walczak K, Opper K, Derse AR, Johnston FMAuthors
Arthur R. Derse MD, JD Director, Professor in the Institute for Health and Equity department at Medical College of WisconsinWendy L. Peltier MD Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Advance Care PlanningChoice Behavior
Female
Humans
Male
Medical Oncology
Pilot Projects
Program Evaluation
Retrospective Studies
Terminal Care
Tertiary Care Centers
Wisconsin
