Trends in Advance Care Planning in Patients With Cancer: Results From a National Longitudinal Survey

TitleTrends in Advance Care Planning in Patients With Cancer: Results From a National Longitudinal Survey
Publication TypeJournal Article
Year of Publication2015
AuthorsNarang, AK, Wright, AA, Nicholas, LHersch
JournalJAMA oncology
Volume1
Issue5
Pagination601-8
KeywordsEnd of life decisions, Other, Retirement Planning and Satisfaction
Abstract

IMPORTANCE: Advance care planning (ACP) may prevent end-of-life (EOL) care that is nonbeneficial and discordant with patient wishes. Despite long-standing recognition of the merits of ACP in oncology, it is unclear whether participation in ACP by patients with cancer has increased over time. OBJECTIVES: To characterize trends in durable power of attorney (DPOA) assignment, living will creation, and participation in discussions of EOL care preferences and to explore associations between ACP subtypes and EOL treatment intensity as reflected in EOL care decisions and terminal hospitalizations. DESIGN, SETTING, AND PARTICIPANTS: We analyzed prospectively collected survey data from 1985 next-of-kin surrogates of Health and Retirement Study (HRS) participants with cancer who died between 2000 and 2012, including data from in-depth exit interviews conducted with the surrogates after the participant's death. The HRS is a nationally representative, biennial, longitudinal panel study of US residents older than 50 years. Trends in ACP subtypes were tested, and multivariable logistic regression models examined for associations between ACP subtypes and measures of treatment intensity. MAIN OUTCOMES AND MEASURES: Trends in the surrogate-reported frequency of DPOA assignment, living will creation, and participation in discussions of EOL care preferences; associations between ACP subtypes and both surrogate-reported EOL care decisions and terminal hospitalizations. RESULTS: From 2000 to 2012, there was an increase in DPOA assignment (52 to 74 , P=.03), without significant change in use of living wills (49 to 40 , P=.63) or EOL discussions (68 to 60 , P=.62). Surrogate reports that patients received all care possible at EOL increased during the period (7 to 58 , P=.004), and rates of terminal hospitalizations were unchanged (29 to 27 , P=.70). Limiting or withholding treatment was associated with living wills (adjusted odds ratio AOR , 2.51; 95 CI, 1.53-4.11; P .001) and EOL discussions (AOR, 1.93; 95 CI, 1.53-3.14; P=.002) but not with DPOA assignment. CONCLUSIONS AND RELEVANCE: Use of DPOA increased significantly between 2000 and 2012 but was not associated with EOL care decisions. Importantly, there was no growth in key ACP domains such as discussions of care preferences. Efforts that bolster communication of EOL care preferences and also incorporate surrogate decision makers are critically needed to ensure receipt of goal-concordant care.

Notes

Times Cited: 0 0

DOI10.1001/jamaoncol.2015.1976
Endnote Keywords

advance care planning/Durable power of attorney/end of life/living will

Endnote ID

999999

Citation Key8201
PubMed ID26181909
PubMed Central IDPMC4537325