Study Examines Lack of Communication Between Health Care Staff, Elderly Patients and Their Families About Advanced Care Plan


A study by Daren K. Heyland, M.D., M.Sc., of Kingston General Hospital, Ontario, Canada and colleagues examined elderly patients’ advance care planning activities before hospitalization and preferences for care from the perspectives of patients and family members. (Online First)

 A total of 278 elderly patients who were at high risk of dying in the next 6 months and 225 family members participated in the in-person administered questionnaire at 12 acute care hospitals in Canada between September 2011 and March 2012.

 Before hospitalization, most patients (76.3 percent) had thought about end-of-life (EOL) care, and 11.9 percent preferred life-prolonging care; 47.9 percent of patients had completed an advance care plan, and 73.3 percent had formally named a surrogate decision maker for health care. Of patients who had discussed their wishes, 30.3 percent had done so with the family physician and 55.3 percent with any member of the health care team. Agreement between patients’ expressed preferences for EOL care and documentation in the medical record was 30.2 percent. Family members’ perspectives were similar to those of patients.

“For the most part, these patients and their family members have considered their wishes for medical treatments at the EOL, but there has been very little communication with health care professionals (either before or during hospitalization) and inadequate documentation of these wishes,” the study concludes.

(JAMA Intern Med. Published online April 1, 2013. doi:10.1001/jamainternmed.2013.180.