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Predictors of Advance Care Planning Documentation in Patients With Underlying Chronic Illness Who Died of Traumatic Injury
- Source :
- J Pain Symptom Manage
- Publication Year :
- 2019
-
Abstract
- CONTEXT. Advance care planning (ACP) is difficult in the setting of a life-threatening trauma but may be equally important in this context, especially with increasing numbers of trauma victims being elderly or having multimorbidity. OBJECTIVES. Identify predictors of absent ACP documentation in the electronic health records of patients with underlying chronic illness who died of traumatic injury. METHODS. We used death records and electronic health records to identify decedents with chronic life-limiting illness who died of traumatic injury between 2010 and 2015 and to evaluate factors associated with documentation of living wills, durable powers of attorney, or physician orders for life-sustaining treatment. RESULTS. Only 22% of decedents had ACP documentation at time of injury. Among those without preinjury ACP documentation, 4% completed ACP documentation after injury. In multipredictor analyses, patients were less likely to have ACP documentation at the time of injury if they were younger (P < 0.001), had fewer chronic illnesses (P = 0.002), and had fewer nonsurgical hospitalizations (P = 0.042) in the year before injury. Among patients without ACP documentation before injury, those with fewer postinjury nonsurgical hospitalizations were less likely to complete ACP documentation after injury (P = 0.019). CONCLUSIONS. Our findings suggest that patient characteristics play an important role in the completion of ACP among patients with chronic life-limiting illness and who died from sudden severe injury. Interventions to improve ACP completion by patients with serious chronic conditions have the potential for increasing goal-concordant care in the event of traumatic injury.
- Subjects :
- Advance care planning
Male
medicine.medical_specialty
Psychological intervention
Context (language use)
Documentation
Article
03 medical and health sciences
Advance Care Planning
0302 clinical medicine
Medicine
Electronic Health Records
Humans
In patient
030212 general & internal medicine
Trauma victims
General Nursing
Aged
Aged, 80 and over
Severe injury
business.industry
Middle Aged
humanities
Anesthesiology and Pain Medicine
Traumatic injury
030220 oncology & carcinogenesis
Emergency medicine
Chronic Disease
Wounds and Injuries
Female
Neurology (clinical)
business
Advance Directives
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- J Pain Symptom Manage
- Accession number :
- edsair.doi.dedup.....4bd44ffc5ca1885c640a8f17d6669c16