Failure to engage hospitalized elderly patients and their families in advance care planning
Abstract
IMPORTANCE: Advance care planning can improve patient-centered care and potentially reduce intensification of care at the end of life. OBJECTIVES: To inquire about patients' advance care planning activities before hospitalization and preferences for care from the perspectives of patients and family members, as well as to measure real-time concordance between expressed preferences for care and documentation of those preferences in the medical record. DESIGN: Prospective study. SETTING: Twelve acute care hospitals in Canada. PARTICIPANTS: Elderly patients who were at high risk of dying in the next 6 months and their family members. MAIN OUTCOME MEASURES: Responses to an in-person administered questionnaire and concordance of expressed preferences and orders of care documented in the medical record. RESULTS: Of 513 patients and 366 family members approached, 278 patients (54.2%) and 225 family members (61.5%) consented to participate. The mean ages of patients and family members were 80.0 and 60.8 years, respectively. Before hospitalization, most patients (76.3%) had thought about end-of-life (EOL) care, and only 11.9% preferred life-prolonging care; 47.9% of patients had completed an advance care plan, and 73.3% had formally named a surrogate decision maker for health care. Of patients who had discussed their wishes, only 30.3% had done so with the family physician and 55.3% 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%. Family members' perspectives were similar to those of patients. CONCLUSIONS AND RELEVANCE: Many elderly patients at high risk of dying and their family members have expressed preferences for medical treatments at the EOL. However, communication with health care professionals and documentation of these preferences remains inadequate. Efforts to reduce this significant medical error of omission are warranted.
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Timely and high-quality assessment of patients' goals of care remains a significant shortcoming in health systems.
“However, timely and high-quality assessment of patients’ goals of care remains a significant shortcoming in health systems.9–11”
From Assessment of a Zero-Shot Large Language Model in Measuring Documented Goals-of-Care Discussions (2026) · cites this paper as [9]
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- Authors
- Heyland, D. K.
- Affiliations
- Kingston General Hospital (CA)
- Corresponding author
- Heyland, Daren K.
- ORCID
- Heyland, Daren K.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2013-05-13
- Volume
- 173
- Issue
- 9
- Pages
- 778
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2117711248
- Cited by
- 496
- References
- 35
- Citations by year
- 2026: 13 · 2025: 28 · 2024: 22 · 2023: 28 · 2022: 32 · 2021: 52 · 2020: 50 · 2019: 49 · 2018: 48 · 2017: 49 · 2016: 45 · 2015: 34 · 2014: 26 · 2013: 20
- FWCI
- 42.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- advance care planning, elderly patients, hospitalized older adults, end-of-life care, family involvement, surrogate decision-making, advance directives, clinical documentation, patient preferences
- MeSH terms
- Adult, Aged, Aged, 80 and over, Canada, Family, Female, Humans, Inpatients, Male, Medical Records, Middle Aged, Prospective Studies, Quality of Life, Surveys and Questionnaires, Terminal Care, Advance Directives, Patient-Centered Care, Advance Care Planning, Patient Preference
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