TY - JOUR
T1 - Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis
T2 - A Pilot Study
AU - Patel, Arpan
AU - Kogekar, Nina
AU - Agarwal, Ritu
AU - Cohen, Cynthia
AU - Esteban, James Phillip
AU - Pourmand, Kamron
AU - Tsai, Eugenia
AU - Harty, Alyson
AU - Pelham-Braithwaite, Andre
AU - Perumalswami, Ponni
AU - Dieterich, Douglas
AU - Schiano, Thomas
N1 - Funding Information:
This research was supported by the Advanced/Transplant Hepatology Fellowship Award (American Association for the Study of Liver Diseases) and the Specialty Training and Advanced Research (STAR) program at University of California, Los Angeles (Arpan Patel).
Publisher Copyright:
© 2019
PY - 2020/4
Y1 - 2020/4
N2 - Background: Despite significant morbidity and mortality among patients with decompensated cirrhosis, reported rates of advance directive (AD) completion and goals of care discussions (GCDs) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention. Measures: Rates of AD and GCD completion, as well as self-reported barriers to ACP. Intervention: Provider-led ACP in patients with decompensated cirrhosis without a prior documented AD. Outcomes: Sixty-two patients were seen over 115 clinic visits. After the intervention, AD completion rates increased from 8% to 31% and GCD completion rates rose from 0% to 51%. Women (P = 0.048) and nonmarried adults (P = 0.01) had greater changes in AD completion compared to men and married adults, respectively. Needing more time during visits was seen as the major barrier to ACP among providers. Conclusions/Lessons Learned: Addressing provider and system-specific barriers dramatically improved documentation rates of ACP.
AB - Background: Despite significant morbidity and mortality among patients with decompensated cirrhosis, reported rates of advance directive (AD) completion and goals of care discussions (GCDs) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention. Measures: Rates of AD and GCD completion, as well as self-reported barriers to ACP. Intervention: Provider-led ACP in patients with decompensated cirrhosis without a prior documented AD. Outcomes: Sixty-two patients were seen over 115 clinic visits. After the intervention, AD completion rates increased from 8% to 31% and GCD completion rates rose from 0% to 51%. Women (P = 0.048) and nonmarried adults (P = 0.01) had greater changes in AD completion compared to men and married adults, respectively. Needing more time during visits was seen as the major barrier to ACP among providers. Conclusions/Lessons Learned: Addressing provider and system-specific barriers dramatically improved documentation rates of ACP.
KW - Advance care planning
KW - advance directives
KW - cirrhosis
KW - goals of care
UR - http://www.scopus.com/inward/record.url?scp=85078362981&partnerID=8YFLogxK
U2 - 10.1016/j.jpainsymman.2019.12.355
DO - 10.1016/j.jpainsymman.2019.12.355
M3 - Article
C2 - 31881290
AN - SCOPUS:85078362981
VL - 59
SP - 864
EP - 870
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
SN - 0885-3924
IS - 4
ER -