Benefits of Structured Advance Care Plan in end-of-Life Care Planning among Older Oncology Patients: A Retrospective Pilot Study

Author:

Burghout Carolien123,Nahar-van Venrooij Lenny M. W.2,Bolt Sascha R.3,Smilde Tineke J.1,Wouters Eveline J. M.34

Affiliation:

1. Department of hemato-oncology, Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands

2. Jeroen Bosch Academy Research, Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands

3. Department of Tranzo, Tilburg University, School of Social and Behavioral Sciences, Tilburg, Netherlands

4. Fontys University of Applied Science, School For Allied Health Professionals, Eindhoven, Noord-Brabant, Netherlands

Abstract

Objectives: Studies suggest that advance care planning (ACP) results in improved quality of life and reduced healthcare consumption. We assessed how the use of a structured advance care planning tool (ACPT) in oncology patients relates to their healthcare consumption before death, and to the match between preferred and actual place of death. Methods: We performed a pilot study at a teaching hospital in the Netherlands. Endpoints were 1) healthcare consumption at three and one month(s) before death, and 2) the match between preferred and actual place of death. Results: The study included 75 patients without an ACPT (group 1) and 59 patients with an ACPT (group 2) of whom the preferred place of care or death were documented at least three months before death in 15 patients (subgroup 2b). Compared to group 1, patients in group 2 had significantly more healthcare consumption. However, compared to group 1, patients in subgroup 2b underwent significantly less diagnostic (33.3% (n  =  5) versus 69.3% (n  =  52), p < 0.05) and laboratory tests (33.3% (n  =  5) versus 62.7% (n  =  47), p < 0.05) one month before death. Patients in subgroup 2b died at their preferred place more often (76.9%, n  =  10) compared to patients in group 1 (58.3%, n  =  7) (NS), which meant more deaths at home and less in-hospital-deaths. Conclusions: The results suggest that timely documentation of the preferred place of care or death in a structured ACPT may result in less healthcare consumption and a better match between the preferred and actual place of death.

Publisher

SAGE Publications

Subject

General Medicine

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