Table 26:
Summary of the Highest-Quality Evidence on Outcomes of Patient Care Planning Discussions
| Outcome | Single-Provider Discussion vs. Usual Care or No Discussion | Team-Based Discussion vs. Usual Care or No Discussion | ||
|---|---|---|---|---|
| Effect Estimate (95% CI) | GRADE | Effect Estimate (95% CI) | GRADE | |
| Patient's QoL |
SMD 0.47 (−0.58, 1.52) 0.44 (−0.52, 1.37) 0.34 (−0.13, 0.80)a,b 0.01 (−0.19, 0.20) |
Very low |
SMD 0.03 (−0.17, 0.23) |
Moderate |
| Informal caregiver's QoL | Estimates NA | Very low | NA | |
| Patient's satisfaction with EoL care |
OR Very satisfied: 8.24 (3.72, 18.26)a Satisfied or very satisfied: 4.00 (0.83, 19.19) MD −0.2 (−3.4, 2.9) SMD −0.96 (−1.61, −0.32)a |
Moderate |
SMD 0.39 (0.17, 0.60)a |
High |
| Family's satisfaction with EoL care |
OR Very satisfied: 5.17 (1.52, 17.58)a Satisfied or very satisfied: 2.48 (0.55, 11.10) MD 2.10 (1.75, 2.45)a 4.6 |
High | NA | |
| Concordance between patient's wishes and care received |
OR 1.73 (0.76, 3.90) |
High | NA | |
| Concordance between patient's and family's wishes |
OR 4.32, P < 0.001a MD 1.4, P = 0.002a |
High | NA | |
| Completion of ACP documents and processes |
Differences in Proportions 25% (17, 33)a 77% (70, 83)a 13% (5, 19)a |
High |
Differences in Proportions 22% (15, 30)a |
High |
| Receiving chemotherapy at EoL |
OR 0.50 (0.35, 0.72)a |
Low | NA | |
| Resuscitation |
OR 0.13 (0.03, 0.55)a |
Very low | NA | |
| Receiving hospital care |
MD −0.21, P = 0.04a |
High |
MD 0.40 (−0.24, 1.04)b |
Low |
| Hospital LOS |
MD −1.8, P = 0.03a |
High |
MD 0 −3.00 (−6.07, 0.07)a,b |
Low |
| ED visits |
MD −1.27 (−3.34, 0.80) |
Low |
MD −0.10 (−1.16, 0.96) |
Moderate |
| ICU care |
OR 0.44 (0.13, 1.53) |
Very low | NA | |
| ICU LOS | NA |
MD −2 −1.50 (−3.48, 0.48) |
High | |
| Home health visits |
MD 0.49 (−2.57, 3.55) |
Very low | NA | |
| Urgent care visits | NA |
MD −0.30 (−0.61, 0.01)a,b |
Moderate | |
| Other outpatient visits |
MD 2.39 (−4.18, 8.96) |
Low |
MD −5.20 (−9.70, −0.70)a |
Moderate |
| Receiving hospice care |
OR 5.17 (2.03, 13.17)a |
High | NA | |
Abbreviations: ACP, advance care planning; CI, confidence interval; ED, emergency department; EoL, end of life; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; ICU, intensive care unit; LOS, length of stay; MD, difference in means; NA, not available; OR, odds ratio; QoL, quality of life; SMD, standardized mean difference.
a
Statistically significant at P ≤ 0.05.
b
Significant difference was shown in the paper, but the difference was not significant in this estimate because the standard deviations for the MDs were estimated conservatively.