title: Determining Consistency of Surrogate Decisions and End-of-Life Care Received with Patient Goals-of-Care Preferences.
abstract: Care consistent with preferences is the goal of advance care planning (ACP). However, comparing written preferences to actual end-of-life care may not capture consistency of care with preferences.
  
  
  
  We evaluated four additional types of consistency, using prospective data on written preferences and active clinical decision making by patients and their surrogates.
  
  
  
  Secondary analysis of data was done from a trial of an ACP intervention for patient-surrogate dyads. Forty-five patients died during the trial and comprised the sample for the analysis. Sources of data included patients' preferences in a written goals-of-care tool, medical record reviews, and two-week postbereavement interviews with surrogates to complement medical record reviews.
  
  
  
  Twenty-four patients (53.3%) received care consistent with written preferences and 11 (24.4%) inconsistent with written preferences. The remaining 10 patients (22.2%) died suddenly with no opportunity for treatment decision making. Eleven (24.4%) were able to participate in decision making with their surrogates; of those, 9 (81.8%) received care consistent with their expressed preferences. Twenty-two patients were incapacitated and thus the surrogate made treatment decisions alone; of those, 18 (81.8%) made decisions consistent with the patient's written preference.
  
  
  
  Simply comparing documented preferences for end-of-life care and medical records of care delivered does not adequately reflect the process of ACP and treatment decision making at the end of life. To understand consistency between preferences and end-of-life care, investigators need data on written and real-time expressed preferences.
authors.affiliation: 1 Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta, Georgia .
authors.forename: Mi-Kyung
authors.initials: MK
authors.lastname: Song
authors.affiliation: 2 School of Nursing, University of Wisconsin-Madison , Madison, Wisconsin.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Ward
authors.affiliation: 3 School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
authors.affiliation: 4 School of Nursing, University of Virginia , Charlottesville, Virginia.
authors.forename: Maureen
authors.initials: M
authors.lastname: Metzger
authors.affiliation: 5 School of Nursing, Kyungpook National University , Daegu, Korea.
authors.forename: SuHyun
authors.initials: S
authors.lastname: Kim
mesh_terms: D032722:Advance Care Planning; D003657:Decision Making; D006040:Goals; D006801:Humans; D011446:Prospective Studies; D013727:Terminal Care