Documentation of advance care planning for community-dwelling elders.
BACKGROUND
Advance planning for end-of-life care has gained acceptance, but actual end-of-life care is often incongruent with patients' previously stated goals. We assessed the flow of advance care planning information from patients to medical records in a community sample of older adults to better understand why advance care planning is not more successful.


METHODS
Our study used structured interview and medical record data from community-dwelling older patients in two previous studies: Assessing Care of Vulnerable Elders (ACOVE)-1 (245 patients age > or = 65 years and screened for high risk of death/functional decline in 1998-1999) and ACOVE-2 (566 patients age > or = 75 who screened positive for falls/mobility disorders, incontinence, and/or dementia in 2002-2003). We compared interview data on patients' preferences, advance directives, and surrogate decision-makers with findings from the medical record.


RESULTS
In ACOVE-1, 38% of surveyed patients had thought about limiting the aggressiveness of medical care; 24% of surveyed patients stated that they had spoken to their doctor about this. The vast majority of patients (88%-93%) preferred to die rather than remain permanently in a coma, on a ventilator, or tube fed. Regardless of patients' specific preferences, 15%-22% of patients had preference information in their medical record. Among patients who reported that they had completed an advance directive and had given it to their health-care provider, 15% (ACOVE-1) and 47% (ACOVE-2) had advance directive information in the medical record. Among patients who had not completed an advance directive but had given surrogate decision-maker information to their provider, 0% (ACOVE-1) and 16% (ACOVE-2) had documentation of a surrogate decision-maker in the medical record.


CONCLUSIONS
Community-dwelling elders' preferences for end-of-life care are not consistent with documentation in their medical records. Electronic health records and standardized data collection for end-of-life care could begin to ameliorate this problem.
Yung
Victoria Y
VY
David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Walling
Anne M
AM
Min
Lillian
L
Wenger
Neil S
NS
Ganz
David A
DA
D032722:Advance Care Planning / Q000592:standards*; D024362:Advance Directive Adherence; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D004282:Documentation / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly; D006801:Humans; D057187:Independent Living; D008297:Male; D008329:Managed Care Programs; D008499:Medical Records; D057240:Patient Preference; D011787:Quality of Health Care