Association of experience with illness and end-of-life care with advance care planning in older adults. 2014

Halima Amjad, and Virginia Towle, and Terri Fried
Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut.

OBJECTIVE To examine whether experiences with illness and end-of-life care are associated with readiness to participate in advance care planning (ACP). METHODS Observational cohort study. METHODS Community. METHODS Persons aged 60 and older recruited from physician offices and a senior center. METHODS Participants were asked about personal experience with major illness or surgery and experience with others' end-of-life care, including whether they had made a medical decision for someone dying, knew someone who had a bad death due to too much or too little medical care, or experienced the death of a loved one who made end-of-life wishes known. Stages of change were assessed for specific ACP behaviors: completion of living will and healthcare proxy, communication with loved ones regarding life-sustaining treatments and quantity versus quality of life, and communication with physicians about these same topics. Stages of change included precontemplation, contemplation, preparation, and action or maintenance, corresponding to whether the participant was not ready to complete the behavior, was considering participation in the next 6 months, was planning participation within 30 days, or had already participated. RESULTS Of 304 participants, 84% had one or more personal experiences or experience with others. Personal experiences were not associated with greater readiness for most ACP behaviors. In contrast, having one or more experiences with others was associated with greater readiness to complete a living will and healthcare proxy, discuss life-sustaining treatment with loved ones, and discuss quantity versus quality of life with loved ones and with physicians. CONCLUSIONS Older individuals who have experience with end-of-life care of others demonstrate greater readiness to participate in ACP. Discussions with older adults regarding these experiences may be a useful tool in promoting ACP.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D001294 Attitude to Health Public attitudes toward health, disease, and the medical care system. Health Attitude,Attitude, Health,Attitudes, Health,Health Attitudes,Health, Attitude to
D013727 Terminal Care Medical and nursing care of patients in the terminal stage of an illness. End-Of-Life Care,End of Life Care,Care, End-Of-Life,Care, Terminal,End-Of-Life Cares
D015331 Cohort Studies Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. Birth Cohort Studies,Birth Cohort Study,Closed Cohort Studies,Cohort Analysis,Concurrent Studies,Historical Cohort Studies,Incidence Studies,Analysis, Cohort,Cohort Studies, Closed,Cohort Studies, Historical,Studies, Closed Cohort,Studies, Concurrent,Studies, Historical Cohort,Analyses, Cohort,Closed Cohort Study,Cohort Analyses,Cohort Studies, Birth,Cohort Study,Cohort Study, Birth,Cohort Study, Closed,Cohort Study, Historical,Concurrent Study,Historical Cohort Study,Incidence Study,Studies, Birth Cohort,Studies, Cohort,Studies, Incidence,Study, Birth Cohort,Study, Closed Cohort,Study, Cohort,Study, Concurrent,Study, Historical Cohort,Study, Incidence
D032722 Advance Care Planning Discussions with patients and/or their representatives about the goals and desired direction of the patient's care, particularly end-of-life care, in the event that the patient is or becomes incompetent to make decisions. Advance Health Care Planning,Advance Medical Planning,Medical Planning, Advance,Planning, Advance Medical

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