Early intervention in planning end-of-life care with ambulatory geriatric patients: results of a pilot trial

Arch Intern Med. 2002 Jul 22;162(14):1611-8. doi: 10.1001/archinte.162.14.1611.


Background: A large discrepancy exists between the wishes of dying patients and their actual end-of-life care. However, retrospective clinical experience suggests that early advance care planning (ACP) can markedly reduce this discrepancy. This article describes a randomized trial to evaluate the short-term clinical utility of early ACP. We also assessed the feasibility of performing a larger prospective study to document long-term outcomes.

Methods: Ambulatory geriatric patients (N = 61) were randomized to either a control group, which received only a Massachusetts Health Care Proxy form to complete, or an intervention group, in which each patient and health care agent discussed ACP with a trained nurse facilitator. The benefits and burdens of life-sustaining treatments were discussed, and patient goals and preferences for these treatments were documented.

Results: Two-month follow-up revealed that the intervention achieved higher congruence between agents and patients in their understanding of patients' end-of-life care preferences, with 76% (19/25) in complete agreement vs 55% (12/22) of the controls (effect size [ES] = -0.43). There was also a greater increase in patient knowledge about ACP in the intervention group (ES = 0.22). Intervention patients became less willing to undergo life-sustaining treatments for a new serious medical problem (ES = -0.25), more willing to undergo such treatments for an incurable progressive disease (ES = 0.24), and less willing to tolerate poor health states (ES = -0.78). Practical insights were gained about how to conduct a larger study more effectively.

Conclusion: A facilitated discussion about end-of-life care between patients and their health care agents helps define and document the patient's wishes for both patient and agent.

Publication types

  • Clinical Trial
  • Comparative Study
  • Evaluation Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Care Planning*
  • Advance Directives
  • Aged
  • Aged, 80 and over
  • Ambulatory Care*
  • Attitude to Health
  • Decision Making
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Patient Care Planning*
  • Patient Education as Topic
  • Pilot Projects
  • Prospective Studies
  • Quality of Life
  • Terminal Care*
  • Terminally Ill*
  • Time Factors
  • Treatment Outcome