The impact of advance care planning on end of life care in elderly patients: randomised controlled trial

BMJ. 2010 Mar 23:340:c1345. doi: 10.1136/bmj.c1345.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Care Planning / organization & administration*
  • Advance Directive Adherence / standards
  • Aged
  • Aged, 80 and over
  • Family Health
  • Female
  • Humans
  • Male
  • Patient Satisfaction / statistics & numerical data
  • Prospective Studies
  • Surveys and Questionnaires
  • Terminal Care / methods*
  • Terminal Care / standards
  • Terminally Ill / psychology
  • Treatment Outcome
  • Victoria