Advanced care planning (ACP) can lead to more terminally ill patients being able to die in their own homes instead of in a hospital, according to a study published in BMJ Supportive & Palliative Care.
“(ACP) can be a way to meet patients’ end-of-life preferences and enhance awareness of end-of-life care. Thereby it may affect (APOD) and decrease the rate of hospitalizations,” the study authors wrote in their abstract.
“The aim was to investigate if ACP among terminally ill patients with lung, heart and cancer diseases effects fulfilment of preferred place of death (PPOD), amount of time spent in hospital and APOD.”
In this randomized controlled trial, researchers recruited 205 patients and placed them into groups: one group received usual care and the other received usual care plus ACP. The intervention arm consisted of a discussion between a healthcare professional, the patient and their relatives about preferences for end-of-life care. The researchers documented and filed these discussions.
The results showed that 111 patients died during follow-up. The researchers observed no significant differences between groups in fulfillment of PPOD (35% vs 52%, p=0.221) or in amount of time spent in hospital among deceased patients (49% vs 23%, p=0.074). However, they did find a notable difference in APOD which favored home death in the intervention group (17% vs 40%, p=0.013).
Advance care planning and place of death, hospitalisation and actual place of death in lung, heart and cancer disease: a randomised controlled trial. https://t.co/lWt9Z6vshQ
— palliativewise (@palliativewise) April 13, 2019
The study authors wrote in their conclusion that: “Concerning the primary outcome, fulfilment of PPOD, and the secondary outcome, time spent in hospital, no differences were found. A significant difference concerning APOD was found, as more patients in the intervention group died at home, compared with the usual care group.”
RCT of Advance Care Planning in heart disease, lung disease and cancer. No differences in achieving preferred place of death or time in hospital, but home deaths increased. @BMJ_SPCare https://t.co/TloNip3Mlw
— Prof Katherine Sleeman (@kesleeman) April 24, 2019