Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis: A Pilot Study

Arpan Patel; Nina Kogekar; Ritu Agarwal; Cynthia Cohen; James Phillip Esteban; Kamron Pourmand; Eugenia Tsai; Alyson Harty; Andre Pelham-Braithwaite; Ponni Perumalswami; Douglas Dieterich; Thomas Schiano

doi:10.1016/j.jpainsymman.2019.12.355

Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis: A Pilot Study

Arpan Patel, Nina Kogekar, Ritu Agarwal, Cynthia Cohen, James Phillip Esteban, Kamron Pourmand, Eugenia Tsai, Alyson Harty, Andre Pelham-Braithwaite, Ponni Perumalswami, Douglas Dieterich, Thomas Schiano

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	864-870
Number of pages	7
Journal	Journal of Pain and Symptom Management
Volume	59
Issue number	4
DOIs	https://doi.org/10.1016/j.jpainsymman.2019.12.355
State	Published - Apr 2020

Keywords

Advance care planning
advance directives
cirrhosis
goals of care

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Patel, A., Kogekar, N., Agarwal, R., Cohen, C., Esteban, J. P., Pourmand, K., Tsai, E., Harty, A., Pelham-Braithwaite, A., Perumalswami, P., Dieterich, D., & Schiano, T. (2020). Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis: A Pilot Study. Journal of Pain and Symptom Management, 59(4), 864-870. https://doi.org/10.1016/j.jpainsymman.2019.12.355

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title = "Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis: A Pilot Study",

abstract = "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.",

keywords = "Advance care planning, advance directives, cirrhosis, goals of care",

author = "Arpan Patel and Nina Kogekar and Ritu Agarwal and Cynthia Cohen and Esteban, {James Phillip} and Kamron Pourmand and Eugenia Tsai and Alyson Harty and Andre Pelham-Braithwaite and Ponni Perumalswami and Douglas Dieterich and Thomas Schiano",

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doi = "10.1016/j.jpainsymman.2019.12.355",

language = "English",

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Patel, A, Kogekar, N, Agarwal, R, Cohen, C, Esteban, JP, Pourmand, K, Tsai, E, Harty, A, Pelham-Braithwaite, A, Perumalswami, P, Dieterich, D & Schiano, T 2020, 'Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis: A Pilot Study', Journal of Pain and Symptom Management, vol. 59, no. 4, pp. 864-870. https://doi.org/10.1016/j.jpainsymman.2019.12.355

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

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.

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SN - 0885-3924

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JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

IS - 4

ER -

Improving Advance Care Planning in Outpatients With Decompensated Cirrhosis: A Pilot Study

Abstract

Keywords

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