title: Use of a values inventory as a discussion aid about end-of-life care: A pilot randomized controlled trial.
abstract: We examined the utility of a brief values inventory as a discussion aid to elicit patients' values and goals for end-of-life (EoL) care during audiotaped outpatient physician-patient encounters.
  
  
  
  Participants were seriously ill male outpatients (n = 120) at a large urban Veterans Affairs medical center. We conducted a pilot randomized controlled trial, randomizing 60 patients to either the intervention (with the values inventory) or usual care. We used descriptive statistics and qualitative methods to analyze the data. We coded any EoL discussions and recorded the length of such discussions.
  
  
  
  A total of 8 patients (13%) in the control group and 13 (23%) in the intervention group had EoL discussions with a physician (p = 0.77). All EoL discussions in the control group were initiated by the physician, compared with only five (38%) in the intervention group. Because most EoL discussions took place toward the end of the encounter, discussions were usually brief.
  
  
  
  The outpatient setting has been promoted as a better place for discussing EoL care than a hospital during an acute hospitalization for a chronic serious illness. However, the low effectiveness of our intervention calls into question the feasibility of discussing EoL care during a single outpatient visit. Allowing extra time or an extra visit for EoL discussions might increase the efficacy of advance care planning.
authors.affiliation: VA Health Services Research and Development Center for Innovations in Quality,Effectiveness and Safety,Michael E. DeBakey Veterans Affairs Medical Center,Houston,Texas.
authors.forename: Shailaja
authors.initials: S
authors.lastname: Menon
authors.affiliation: Center for Medical Ethics and Health Policy,Baylor College of Medicine,Houston,Texas.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.affiliation: Geriatric Research Education Clinical Center,North Florida/South Georgia Veterans Health System,Department of Medicine,University of Florida College of Medicine,Gainesville,Florida.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Beyth
authors.affiliation: Department of Public Health Sciences and Cancer Disparities,Hollings Cancer Center,Medical University of South Carolina,Charleston,South Carolina.
authors.forename: Marvella E
authors.initials: ME
authors.lastname: Ford
authors.affiliation: VA Health Services Research and Development Center for Innovations in Quality,Effectiveness and Safety,Michael E. DeBakey Veterans Affairs Medical Center,Houston,Texas.
authors.forename: Donna
authors.initials: D
authors.lastname: Espadas
authors.affiliation: VA Health Services Research and Development Center for Innovations in Quality,Effectiveness and Safety,Michael E. DeBakey Veterans Affairs Medical Center,Houston,Texas.
authors.forename: Ursula K
authors.initials: UK
authors.lastname: Braun
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010865:Pilot Projects; D012945:Social Values; D013727:Terminal Care / Q000523:psychology*; D013781:Texas; D014728:Veterans / Q000523:psychology*
keywords: Advance care planning; Ambulatory care; Outpatients; Randomized controlled trial; Terminal care; Veterans