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Resident Approaches to Advance Care Planning on the Day of Hospital Admission
Alexander K. Smith, MD, MS;
Angela Poppe Ries, MD;
Baohui Zhang, MS;
James A. Tulsky, MD;
Holly G. Prigerson, PhD;
Susan D. Block, MD
Arch Intern Med. 2006;166:1597-1602.
Background Advance care planning is the process of establishing a patient's goals and preferences for future care. Previous research has demonstrated a need to improve patient-physician communication around advance care planning. A critical time for advance care planning conversations is the day of admission to the hospital.
Methods A survey of internal medicine residents was administered at Duke University Medical Center and the Brigham and Women's Hospital, 2 major academic teaching centers. Residents were questioned about their approaches to advance care planning on their last on-call admitting day.
Results Of 347 residents solicited, 292 (84.1%) participated in the survey. Residents reported that they established preferences for cardiopulmonary resuscitation (CPR) with 70.5% of patients, established a health care proxy with 33.7% of patients, discussed goals and values concerning end-of-life care with 32.0% of patients, and asked 35.6% of patients if they had an advance directive. Although 89.0% of residents had observed an advance care planning discussion model, only 66.4% had received teaching and 36.6% had received feedback about advance care planning conversations. In multivariable analysis, having received feedback about advance care planning conversations was associated with a higher percentage of conversations about health care proxy and goals and values related to the end of life.
Conclusions Residents discuss patient preferences for CPR on the day of admission with most patients. Preparing residents, particularly through feedback, may improve communication around other elements of advance care planning.
Author Affiliations: Division of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (Drs Smith, Prigerson, and Block and Ms Zhang), and Departments of Psychiatry (Drs Prigerson and Block) and Medicine (Drs Smith and Block), Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Duke University Medical Center (Drs Ries and Tulsky), and Center for Palliative Care and Department of Medicine, Veterans Affairs Medical Center (Dr Tulsky), Durham, NC.
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