title: When death is imminent - documenting end-of-life decisions.
abstract: BACKGROUND
  There has been widespread promotion of advance care planning in recent years, which is consistent with an ageing population and a greater awareness of patient self determination.
  
  
  METHODS
  A review of medical records relating to hospital patient deaths and a separate review of emergency department admissions of patients aged 75 years or more in the same hospital.
  
  
  RESULTS
  In the patient deaths sample, 77% of patients (median age 79 years), had their first documented end-of-life discussion 3 days before death. In the sample of emergency department admissions, 82% of patients (median age 83 years), had no documented end-of-life discussion or review by the time of discharge. Only two patients, both in the emergency department admissions group, had written advance care plans before admission.
  
  
  CONCLUSIONS
  This study suggests that documented advance care plans are either not being prepared in the community or are not being communicated to acute care facilities. As a result, end-of-life care preferences are documented when death is imminent.
authors.affiliation: University Department of Rural Health & Rural Clinical School, University of Newcastle, Tamworth, New South Wales. mandy.gaw@hnehealth.nsw.gov.au
authors.forename: Amanda
authors.initials: A
authors.lastname: Gaw
authors.forename: Steven
authors.initials: S
authors.lastname: Doherty
authors.forename: Philip
authors.initials: P
authors.lastname: Hungerford
authors.forename: Jenny
authors.initials: J
authors.lastname: May
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009517:New South Wales; D012189:Retrospective Studies