Examining Advance Care Planning's Role in End-of-Life Care Decisions

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Between 2000 and 2012, the use of durable power of attorney (DPOA) increased significantly but no association was established between it and end-of-life (EOL) care decisions, according to an article published online in the journal JAMA Oncology.

The authors aimed to establish trends between subtypes of advance care planning (ACP) and EOL treatment intensity in care decisions. Measured trends included the DPOA assignment reported by surrogates, living will creation, and participation in EOL care preferences discussions.

The data set included 1,985 next-of-kin surrogates of Health and Retirement Study (HRS) participants (patients with cancer) who died between 2000 and 2012.

Results showed an increase in DPOA assignment (52% to 74%, P=0.03), but no significant change in use of living wills or EOL discussions (49% to 40%, P=0.63; 68% to 60%, P=0.62, respectively).

Furthermore, a significant increase was observed in the reporting that patients received “all care possible” at EOL (7% to 58%, P=0.004). However, terminal hospitalization rates remained almost constant (29% to 27%, P=0.70).

An association was found between limiting or withholding treatment and living wills (adjusted odds ratio (AOR), 2.51; 95% CI: 1.53, 4.11; P<0.001) and EOL discussion participation (AOR, 1.93; 95% CI: 1.53, 3.14; P=0.002), but not with surrogate-reported DPOA assignment.

Early integration of palliative care can be beneficial for younger patients.
Between 2000 and 2012, use of durable power of attorney increased significantly but no association established with end-of-life care decisions.
Despite long-standing recognition of the merits of advance care planning (ACP) in oncology, it is unclear whether participation in ACP by patients with cancer has increased over time.
READ FULL ARTICLE From oncology.jamanetwork.com

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