Resident approaches to advance care planning on the day of hospital admission.

Full Abstract

BACKGROUND:
Advance care planning is the process of establishing a patient's goals and preferences for future care. Previous research has demonstrated a need to improve patient-physician communication around advance care planning. A critical time for advance care planning conversations is the day of admission to the hospital.

METHODS:
A survey of internal medicine residents was administered at Duke University Medical Center and the Brigham and Women's Hospital, 2 major academic teaching centers. Residents were questioned about their approaches to advance care planning on their last on-call admitting day.

RESULTS:
Of 347 residents solicited, 292 (84.1%) participated in the survey. Residents reported that they established preferences for cardiopulmonary resuscitation (CPR) with 70.5% of patients, established a health care proxy with 33.7% of patients, discussed goals and values concerning end-of-life care with 32.0% of patients, and asked 35.6% of patients if they had an advance directive. Although 89.0% of residents had observed an advance care planning discussion model, only 66.4% had received teaching and 36.6% had received feedback about advance care planning conversations. In multivariable analysis, having received feedback about advance care planning conversations was associated with a higher percentage of conversations about health care proxy and goals and values related to the end of life.

CONCLUSIONS:
Residents discuss patient preferences for CPR on the day of admission with most patients. Preparing residents, particularly through feedback, may improve communication around other elements of advance care planning.

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Author information

Author/s: Smith, Alexander K (AK); Ries, Angela Poppe (AP); Zhang, Baohui (B); Tulsky, James A (JA); Prigerson, Holly G (HG); Block, Susan D (SD);

Affiliation: Division of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA. asmith17(-atsign-)partners.org

Journal and publication information

Publication Type: Journal Article

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: -2006 Aug 14-28; vol 166 (issue 15) : pp 1597-602

Dates: Created 2006/08/15; Completed 2006/09/14;

PMID: 16908792, status: MEDLINE (last retrieval date: 12/26/2008)

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