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Medline ® Abstracts for References 1-3

of 'Advance care planning and advance directives'

1
TI
The impact of advance care planning on end of life care in elderly patients: randomised controlled trial.
AU
Detering KM, Hancock AD, Reade MC, Silvester W
SO
BMJ. 2010;340:c1345. Epub 2010 Mar 23.
 
OBJECTIVE: To investigate the impact of advance care planning on end of life care in elderly patients.
DESIGN: Prospective randomised controlled trial.
SETTING: Single centre study in a university hospital in Melbourne, Australia.
PARTICIPANTS: 309 legally competent medical inpatients aged 80 or more and followed for six months or until death.
INTERVENTIONS: Participants were randomised to receive usual care or usual care plus facilitated advance care planning. Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes.
MAIN OUTCOME MEASURES: The primary outcome was whether a patient's end of life wishes were known and respected. Other outcomes included patient and family satisfaction with hospital stay and levels of stress, anxiety, and depression in relatives of patients who died.
RESULTS: 154 of the 309 patients were randomised to advance care planning, 125 (81%) received advance care planning, and 108 (84%) expressed wishes or appointed a surrogate, or both. Of the 56 patients who died by six months, end of life wishes were much more likely to be known and followed in the intervention group (25/29, 86%) compared with the control group (8/27, 30%; P<0.001). In the intervention group, family members of patients who died had significantly less stress (intervention 5, control 15; P<0.001), anxiety (intervention 0, control 3; P=0.02), and depression (intervention 0, control 5; P=0.002) than those of the control patients. Patient and family satisfaction was higher in the intervention group.
CONCLUSIONS: Advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives. Trial registration Australian New Zealand clinical trials registry ACTRN12608000539336.
AD
Respecting Patient Choices Program, Austin Health, PO Box 555, Heidelberg, Victoria, Australia. Karen.detering@austin.org.au
PMID
2
TI
Advance care planning: Beyond the living will.
AU
Messinger-Rapport BJ, Baum EE, Smith ML
SO
Cleve Clin J Med. 2009 May;76(5):276-85.
 
For a variety of reasons, the most commonly used advance directive documents (eg, the living will) may not be very useful in many situations that older adults encounter. The durable power of attorney for health care is a more versatile document. We advocate focusing less on "signing away" certain interventions and more on clarifying the goals of care in the ambulatory setting.
AD
Cleveland Clinic Foundation, OH 44195, USA. rapporb@ccf.org
PMID
3
 
 
Respecting Choices. http://www.gundersenhealth.org/respecting-choices (Accessed on August 15, 2013).
 
no abstract available