Table 3.
Advance Care Planning, Surrogate Decision-making, and Utilization
| Variable, n (%) | Cancer | Dementia | CKD | Total |
|---|---|---|---|---|
| N = 134 | N = 134 | N = 134 | N = 402 | |
| Any discussion of advance care planning | 125 (93.28) | 106 (79.10) | 103 (76.87) | 334 (83.08) |
| If any discussion, days before death, median (IQR) | 24 (7–59) | 16.5 (4–64) | 6 (1–23) | 15 (4–50) |
| ACP note | 70 (52.24) | 63 (47.01) | 53 (39.55) | 186 (46.27) |
| Living will | 16 (11.94) | 12 (8.96) | 11 (8.21) | 39 (9.70) |
| MOST/POLST | 4 (2.99) | 14 (10.45) | 4 (2.99) | 22 (5.47) |
| No discussion | 8 (5.97) | 25 (18.66) | 29 (21.64) | 62 (15.42) |
| Family refused | 0 (0.00) | 0 (0.00) | 1 (0.75) | 1 (0.25) |
| Surrogate name and contact information | 106 (79.10) | 120 (89.55) | 111 (82.84) | 337 (83.83) |
| Documented relationship to patient* | 107 (79.85) | 122 (91.04) | 113 (84.33) | 342 (85.07) |
| Spouse/life partner | 47 (35.07) | 32 (23.88) | 44 (32.84) | 123 (30.60) |
| Adult daughter | 26 (19.40) | 51 (38.06) | 30 (22.39) | 107 (26.62) |
| Adult son | 7 (5.22) | 32 (23.88) | 18 (13.43) | 57 (14.18) |
| Parent | 11 (8.21) | 1 (0.75) | 10 (7.46) | 22 (5.47) |
| Adult grandchild | 0 (0.00) | 1 (0.75) | 3 (2.24) | 4 (1.00) |
| Sibling | 16 (11.94) | 5 (3.73) | 6 (4.48) | 27 (6.72) |
| Other | 7 (5.22) | 6 (4.48) | 8 (5.97) | 21 (5.22) |
| Documented no surrogate | 16 (11.94) | 5 (3.73) | 6 (4.48) | 27 (6.72) |
| Spiritual care needs | ||||
| Screened | 82 (61.2) | 56 (41.8) | 83 (61.9) | 221 (55.0) |
| Desired (among screened) | 73 (89.0) | 52 (92.9) | 77 (92.8) | 202 (91.4) |
| Addressed (among screened and desired) | 72 (98.6) | 49 (94.2) | 75 (97.4) | 202 (97.0) |
| Saw a hospital spiritual care provider | 69 (51.5) | 46 (34.33) | 76 (56.72) | 191 (47.5) |
| Utilization | ||||
| Specialty palliative care consult | 71 (52.99) | 32 (23.88) | 42 (31.34) | 145 (36.07) |
| If consult, no. of visits, mean (range) | 4.4 (1–21) | 2.69 (1–7) | 2.21 (1–9) | 3.62 (1–21) |
| If consult, mean/median days before death (IQR) | 32 (12–73) | 39 (8.5–74.5) | 39 (4–51) | 30 (8–72) |
| Other palliative care services | ||||
| Outpatient oncology palliative care | 25 (18.66) | 0 (0.00) | 0 (0.00) | 25 (6.22) |
| Home-based serious illness care | 0 (0.00) | 7 (5.22) | 4 (2.99) | 11 (2.74) |
| Inpatient specialty palliative care, outside hospital | 2 (1.49) | 0 (0.00) | 0 (0.00) | 2 (0.50) |
| ED | ||||
| Any ED visits, 180 days before index until index | 34 (25.37) | 39 (29.10) | 36 (26.87) | 109 (27.11) |
| If yes, mean (range) | 1.74 (1–14) | 1.95 (1–9) | 1.89 (1–8) | 1.86 (1–14) |
| Hospitalization | ||||
| Any hospitalization, 180 days before index until index | 41 (30.60) | 14 (10.45) | 51 (38.06) | 106 (26.37) |
| If yes, mean (range) | 1.68 (1–9) | 1.28 (1–3) | 0.67 (0–11) | 1.76 (1–11) |
| Encounters (ED + hospitalization) | ||||
| Any encounter, 180 days before index until index | 61 (45.52) | 44 (32.84) | 68 (50.75) | 173 (43.03) |
| If yes, mean (range) | 2.10 (1–14) | 2.14 (1–9) | 2.32 (1–15) | 2.20 (1–15) |
*Sums to > 100%. Some patients had > 1 documented primary surrogate