Does Advance Care Planning Help Patients?Advance care planning program SHARING Choices shows 12% increase in end of life documentation
A study involving nearly 65,000 older patients sought to understand whether primary care practitioners could play a key role in helping more people make end-of-life plans — and if such […]
A study involving nearly 65,000 older patients sought to understand whether primary care practitioners could play a key role in helping more people make end-of-life plans — and if such guidance could also reduce burdensome care.
The finding? Yes and no. That is, such guidance in planning helped, but in some cases, it also presented unexpected results for those who were seriously ill.
The clinical trial was led by John Hopkins’ Health Policy and Management professor Jennifer L. Wolff. The study, published in JAMA Internal Medicine in 2023, followed 64,915 people ages 65 and older between March 2021 and April 2022. Some 23,000 patients were given support tools and more information in their end-of-life planning. The others, nearly 42,000 comprising the control group, were given no such guidance.
SHARING Choices: an advance care planning intervention
The study was based on SHARING Choices, which “aims to improve communication through patient and family engagement in advance care planning.” It does that by providing patients tools including an introduction letter from their practitioners, access to trained advance care planning facilitators, checklists and other useful information.
The good news was that many more people in the guided group did document their desires — about 12% compared with only 6.6% in the control group. Those with dementia saw the most significant increase in documentation.
The surprising finding, however, was that seriously ill patients ended up choosing potentially burdensome care such as life-sustaining procedures that, as researchers noted, might prolong suffering. As Johns Hopkins’ report on results noted, “Among the subset of Maryland residents with serious illness who died within the observation period, 28.8% of those in the intervention group received burdensome care, compared with 20.9% in the control group.”
More studies are needed on advance care planning
As lead author Jennifer L. Wolff said, “Advance care planning is vital for ensuring that patients’ end-of-life wishes are respected, especially in primary care, where long-term relationships with patients make it an ideal setting for these conversations.”
But, as Wolff added, “This finding underscores that documenting end-of-life preferences isn’t always sufficient on its own. End-of-life care decisions are deeply personal, and patients may choose different paths depending on circumstances. However, it does emphasize the need for continuous, nuanced conversations between patients and their health care providers.”
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