Association Between Patient-Reported Engagement and Medical Record of Advance Care Planning Among Older Adults in the ED: A Cross Sectional Study

Abstract

Background

Most older adults in the U.S. visit the emergency department (ED) in their final 6 months of life, providing an opportunity to engage patients in advance care planning (ACP) conversations (ie, a process to formulate and communicate preferences for end-of-life care). While many report ACP engagement, the link between self-reported engagement and pre-existing ACP documentation in the ED, where ACP documentation is especially critical, remains unclear.

Methods

This cross-sectional study is a secondary analysis of the VIDEO-ED trial, a multi-site randomized controlled study evaluating a video-supported ACP intervention in the ED. Patients aged ≥65 years and adults with serious illness (ie, illnesses with a 1-year prognosis) were prospectively enrolled. ACP engagement was measured using the validated ACP Engagement Survey. Medical records were reviewed for ACP documentation, including clinician-documented ACP and advance directives.

Results

Among 570 participants (median age: 73.0 years, IQR: 68.0-79.0), higher ACP engagement scores were associated with greater clinician-documented ACP (OR: 1.47, 95% CI: 1.09-1.98, P = 0.01) and advance directives (OR: 1.40, 95% CI: 1.15-1.71, P < 0.01). Readiness to sign official documents naming a medical decision-maker was particularly predictive of ACP documentation (OR: 1.42, 95% CI: 1.03-1.97, P = 0.03).

Conclusions

On ED presentation, patient-reported ACP engagement correlated with the presence of pre-existing ACP documentation in the EHR. The ACP Engagement Survey may help identify older adults less likely to have documented ACP, guiding targeted interventions in the ED.