Background Advance care planning helps us understand what matters to a person and can be used as a mechanism to encourage advanced treatment decision making and capture advance directives(AD), but is potentially more complex for well patients for whom deterioration and serious illness are difficult to anticipate.
Methods retrospective, aggregated non-identifiable quantitative data from complete electronic advance care plans from the South Island of New Zealand was analysed using the construction of chi-squared and simple descriptive approach.
Results Data from 7148 ACP plans were analysed, 1722 were excluded due to draft/deleted status, 5184(96%) of plans included preferences around resuscitation, patients completing 1883(35%) plans reported that they were well at the time of the completion. Advance treatment decisions in the event of serious illness were compared between ‘well’ versus ‘not-well’ patients. 286(15%) of well versus 420(13%) of not -well patients indicated preference request to receive all treatments that the healthcare team think is appropriate to their situation. 427(23%) of well versus 753(23%) not-well patients indicated only to receive treatments directed at quality of life. 877(47%) of well versus 1710(52%) of not-well patients indicated to only receive treatments that focus on comfort and dignity rather than treatments to prolong life, 293(16%) of well patients were unable to make a decision or offered AD versus 418(16%) of not-well patients, Chi squared test was performed to examine the relationship between wellness and treatment preferences, the relation between these variables was significant, X2(3, N = 5184)=19.27,p=0.00024 suggesting that wellness did impact on decision making.
Conclusion Wellness impacts decision making around treatment preferences, however nearly half of well patients selected to receive only treatments directed at comfort in the setting of serious illness. Further research is needed into the drivers for goals of care decisions for well patients in advance care planning.
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