Table 4.
Medical record review: Concordance between documented preferences for EOL care and care received at the EoL. Difference, 95% CI, and p-values are for Documented and complied with vs (Documented not complied with or not documented)
| Outcomes | N | ACP n (%) | Usual care n (%) | Difference %(95% CI) | p-value |
|---|---|---|---|---|---|
| Concordance and End of Life care received | |||||
| Actual Place of death | 151 | 0.85 | |||
| Hospital | 12 (18) | 16 (19) | |||
| Home/nursing home/ hostel | 13 (19) | 20 (24) | |||
| Hospice/palliative care | 37 (54) | 41 (49) | |||
| Don’t know/other | 6 (9) | 6 (7) | |||
| Place of death | 145 | 24 (8, 39) | 0.003 | ||
| Documented and complied with | 31(49) | 21 (26) | |||
| Documented not complied with | 15 (24) | 14 (17) | |||
| Not documented | 17 (27) | 47 (57) | |||
| CPR received in last 2 weeks | 136 | 0 | 0 | — | — |
| CPR | |||||
| Documented and complied with | 42 (75) | 19 (23) | |||
| Documented not complied with | 2 (4) | 0 (0) | |||
| Not documented | 138 | 12 (21) | 63 (77) | 52 (37, 66) | <0.0001 |
| ICU admission in last 2 weeks | 136 | 1(2) | 0 (0) | 2 (−1, 5) | 0.45 |
| ICU admission | 148 | 17 (4, 30) | 0.008 | ||
| Documented and complied with | 18 (28) | 9 (11) | |||
| Documented not complied with | 0 (0) | 1 (1) | |||
| Not documented | 47 (72) | 74 (88) | |||
| Chemotherapy received in last 4 weeks | 142 | 13 (21) | 11 (14) | 7 (−6, 20) | 0.32 |
| Chemotherapy last 4 weeks | 142 | 2 (13, 17) | 0.82 | ||
| Documented and complied with | 20 (31) | 23 (29) | |||
| Documented not complied with | 11 (17) | 9 (2) | |||
| Not documented | 33 (52) | 46 (59) | |||
| Other significant interventions in last 2 weeks | 136 | 16 (26) | 17 (23) | 4 (−11, 18) | 0.63 |
| Other goals | 139 | −5 (−20, 10) | 0.51 | ||
| Documented and complied with | 14 (24) | 23 (29) | |||
| Documented not complied with | 6 (10) | 4 (5) | |||
| Not documented | 39 (66) | 53 (66) | |||
| Surgery in last 2 weeks | 151 | 1 (2) | 1 (1) | 0 (−4, 4) | 1 |
| Surgery | 142 | 5% (2, 13) | 0.14 | ||
| Documented and complied with | 5 (8) | 2 (2) | |||
| Documented not complied with | 0 (0) | 0 (0) | |||
| Not documented | 58 (92) | 77 (97) | |||
| Mechanical ventilation in last 2 weeks | 143 | 0 (0) | 0 (0) | — | — |
| Mechanical ventilation | 144 | 37 (23, 52) | <0.0001 | ||
| Documented and complied with | 30 (49) | 10 (12) | |||
| Documented not complied with | 4 (7) | 0 (0) | |||
| Not documented | 27 (44) | 73 (88) | |||
| EOL care documents and palliative care | |||||
| Prevalence of formal Advance Care Directives | 150 | 50 (74) | 5 (6) | 67 (56, 79) | <0.0001 |
| Documentation of substitute decision makers at hospital | 151 | 49 (72) | 22 (27) | 46 (31, 60) | <0.0001 |
| Other EOL care documentation | 151 | 52 (76) | 57 (69) | 7 (−6, 22) | 0.29 |
| Documentation of POD preference | 151 | 50 (75) | 35(43) | 32 (17, 47) | <0.0001 |
| POD preference | 85 | 0.04 | |||
| Hospital | 2 (4) | 3 (9) | |||
| Home/nursing home/ hostel | 16 (32) | 19 (54) | |||
| Hospice/palliative care | 22 (44) | 12 (34) | |||
| Other | 10 (20) | 1 (3) | |||
| Timing of Advance Care Directive (median, IQR, months before death) | 55 | 5.0 (2.3, 8.9) | 3.2 (0.8, 3.7) | 0.18 | |
| Contact with palliative care | 146 | 64 (97) | 77 (96) | 0 (−5, 6) | 0.81 |
| Timing of palliative care (median, IQR, months before death) | 135 | 2.0 (.5, 6.9) | 1.6 (0.9, 4.3) | 0.68 |