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The impact of advance care planning on end of life care in elderly patients


British Medical Journal

Type: Report
Region: Republic of Ireland
Northern Ireland

  A recent Australian study on the impact of advance care planning on end of life care in elderly patients features in the current edition of the British Medical Journal. The study led by Karen M Detering, respiratory physician and clinical leader, Andrew D Hancock, project officer, Michael C Reade, physician, William Silvester, intensive care physician and director, followed 309 inpatients aged 80 years and older for six months or until death. The prospective randomised controlled trial was carried out in a university hospital in Melbourne, Australia. InterventionsParticipants were randomised to receive usual care or usual care plus facilitated advance care planning. Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes. Main outcome measuresThe primary outcome was whether a patient’s end of life wishes were known and respected. Other outcomes included patient and family satisfaction with hospital stay and levels of stress, anxiety, and depression in relatives of patients who died. Results154 of the 309 patients were randomised to advance care planning, 125 (81%) received advance care planning, and 108 (84%) expressed wishes or appointed a surrogate, or both. Of the 56 patients who died by six months, end of life wishes were much more likely to be known and followed in the intervention group (25/29, 86%) compared with the control group (8/27, 30%; P<0.001). In the intervention group, family members of patients who died had significantly less stress (intervention 5, control 15; P<0.001), anxiety (intervention 0, control 3; P=0.02), and depression (intervention 0, control 5; P=0.002) than those of the control patients. Patient and family satisfaction was higher in the intervention group. Conclusions Advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives. Correspondence to: K M Detering



Rights: Public
Suggested citation:

British Medical Journal. (2010) The impact of advance care planning on end of life care in elderly patients [Online]. Available from: [Accessed: 24th July 2019].


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