Table 2.
Summary of Adjusted Comparisons of Secondary Outcomes Across Groups
| Outcome | Raw scorea | Estimation method | Adjusted effect estimate (95% CI) | Comfort AD vs standard | Life-extending AD vs standard | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Comfort AD | Standard AD, reference | Life-extending AD | Comfort AD | Life-extending AD | Unadjusted P valueb |
Adjusted P value |
Unadjusted P valueb |
Adjusted P value |
||
| Decision conflict total score, mean (SD)c | 17 (12.4) | 16.2 (13.8) | 17.4 (13.9) | Linear change from reference | 0.51 (−3.83 to 4.85) | 1.5 (−2.91 to 5.9) | .73 | .82 | .60 | .50 |
| Very satisfied with advance care planning, No./total No. (%)d | 68/71 (95.8) | 69/76 (90.8) | 62/69 (89.8) | Odds ratio | 2.31 (0.60 to 11.17) | 0.95 (0.30 to 2.97) | .24 | .25 | .85 | .93 |
| McGill Quality of Life, mean (SD)e | 6.2 (3.2) | 6.4 (3.2) | 5.9 (3.1) | Linear change from reference | 0.11 (−0.85 to 1.07) | −0.04 (−0.99 to 0.92) | .82 | .82 | .38 | .94 |
| Survival, median (iQR), df | 564 (302.8 to 843.2) | 494 (717 to 316) | 553.5 (325.8 to 791.2) | Hazard ratio | 0.66 (0.37 to 1.19) | 0.83 (0.45 to 1.51) | .04 | .17 | .39 | .54 |
| Died in hospital, No./Total No. (%)g | 13/148 (8.8) | 23/149 (15.4) | 14/140 (10) | Odds ratio | 0.52 (0.24 to 1.05) | 0.61 (0.29 to 1.23) | .08 | .08 | .15 | .17 |
| Hospital admissions, median (IQR), No.h | 1 (0 to 2) | 1 (0 to 3) | 1 (0 to 2) | Incident rate ratio | 0.98 (0.72 to 1.33) | 0.87 (0.63 to 1.18) | .57 | .88 | .24 | .37 |
| ICU admissions, median (IQR), No.h | 0 (0 to 0) | 0 (0 to 0) | 0 (0 to 0) | Incident rate ratio | 0.91 (0.46 to 1.81) | 0.84 (0.4 to 1.73) | .72 | .79 | .61 | .64 |
| Total cost of inpatient care, median (IQR), thousands of $i | 28.7 (0 to 188.1) | 60.7 (0 to 267.8) | 31.9 (0 to 162.2) | Log linear change from reference | −1.09 (−2.43 to 0.25) | −0.78 (−2.14 to 0.58) | .11 | .11 | .22 | .26 |
| Cost of inpatient care per hospitalization day, median (IQR), thousands of $i | 6.7 (0 to 3.2) | 9.4 (0 to 15.0) | 7.1 (0 to 16.0) | Log linear change from reference | −0.9 (−1.97 to 0.16) | −0.52 (−1.6 to 0.56) | .09 | .97 | .30 | .35 |
| Receipt of life-sustaining therapy, No./Total No. (%)j | 16/148 (10.8) | 20/149 (13.4) | 15/140 (10.7) | Odds ratio | 0.64 (0.3 to 1.33) | 0.72 (0.34 to 1.51) | .49 | .48 | .24 | .39 |
Abbreviations: AD, advance directive; ICU, intensive care unit; IQR, interquartile range.
The number of responses is different for different outcomes, given that patient-reported outcomes were collected only for per-protocol sample and there are some missing responses.
Unadjusted P values are reported from univariate analysis. The adjustments include patient characteristics such as age, gender, race, and education.
The estimate for patients’ decision conflict scale is the ordinary least square estimate. A total of 71 patients in the comfort AD group, 75 patients in the standard AD group, and 68 patients in the life-extending AD group completed this measure.
Satisfaction scale analyzed as binary variable with levels very satisfied and not very satisfied. The data used in the model were responses of the patients after approximately 2 months of AD completion.
McGill Quality of Life is reported for 247 patients and imputed for 17 patients, for a total of 264 patients (85 in the comfort AD group, 91 in the standard AD group, and 88 in the life-extending AD group). The regression table and imputation method are described in eTable 12 in Supplement 2. The reported estimate is the mean response from linear regression model. Among these 247 scores, 3 are calculated from a surrogate’s response
Survival data were available for all participants. Survival was analyzed using Cox proportional hazards model.
Place of death categorized as death at the hospital and other. The other category includes death at other places and patients who were still alive.
Hospital admissions and ICU admissions are treated as counts, and suitable count models have been used to model those outcomes. The reported estimates are incident rates. Hospital admission data were available for all participants. For ICU admissions, data were available only from Pennsylvania database, representing 143 patients in the comfort AD group, 134 patients in the standard AD group, and 124 patients in the life-extending AD group.
Total cost of inpatient care and cost of inpatient care per day were available for all participants. The cost analysis was done by log transforming inpatient care charges. The reported estimates are βs. The decrease of hospital-free days in the intervention arm = (ex (β)−1) × 100%.
Percentage of patients receiving any 1 of cardiopulmonary resuscitation, mechanical ventilation, dialysis, or surgical feeding tube.