Article Text

PDF
Advance care planning and place of death, hospitalisation and actual place of death in lung, heart and cancer disease: a randomised controlled trial
  1. Marianne Hjorth Skorstengaard1,
  2. Anders Bonde Jensen2,
  3. Pernille Andreassen3,
  4. Trine Brogaard4,
  5. Elisabeth Brendstrup5,
  6. Anders Løkke5,
  7. Susanne Aagaard6,
  8. Henrik Wiggers6 and
  9. Mette Asbjoern Neergaard7
  1. 1Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
  2. 2Oncology Department, Aarhus University Hospital, Aarhus, Denmark
  3. 3Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
  4. 4Research Unit for General Practice, Aarhus Universitetshospital, Aarhus, Denmark
  5. 5Department of Respiratory Diseases and Allergy, Aarhus Universitetshospital, Aarhus, Denmark
  6. 6Department of Cardiology, Aarhus Universitetshospital, Aarhus, Denmark
  7. 7The Palliative Care Team, Oncology Department, Aarhus University Hospital, Aarhus, Denmark
  1. Correspondence to Dr Marianne Hjorth Skorstengaard, Clinical Medicne, Aarhus Universitet, Aarhus 8000, Denmark; marianne.skorstengaard{at}viborg.rm.dk

Abstract

Objectives Advance care planning (ACP) can be a way to meet patients’ end-of-life preferences and enhance awareness of end-of-life care. Thereby it may affect actual place of death (APOD) and decrease the rate of hospitalisations. The aim was to investigate if ACP among terminally ill patients with lung, heart and cancer diseases effects fulfilment of preferred place of death (PPOD), amount of time spent in hospital and APOD.

Methods The study was designed as a randomised controlled trial. Patients were assessed using general and disease-specific criteria and randomised into groups: one received usual care and one received usual care plus ACP. The intervention consisted of a discussion between a healthcare professional, the patient and their relatives about preferences for end-of-life care. The discussion was documented in the hospital file.

Results In total, 205 patients were randomised, of which 111 died during follow-up. No significant differences in fulfilment of PPOD (35% vs 52%, p=0.221) or in amount of time spent in hospital among deceased patients (49% vs 23%, p=0.074) were found between groups. A significant difference in APOD was found favouring home death in the intervention group (17% vs 40%, p=0.013).

Conclusion Concerning the primary outcome, fulfilment of PPOD, and the secondary outcome, time spent in hospital, no differences were found. A significant difference concerning APOD was found, as more patients in the intervention group died at home, compared with the usual care group.

Trial registration number NCT01944813.

  • end-of-life preferences
  • advance care planning
  • heart failure
  • respiratory conditions
  • cancer

Statistics from Altmetric.com

Footnotes

  • Contributors MHS, ABJ, TB and MAN conceptualised, planned and constructed the study. MHA and MAN led on data collection and analysis. All authors were involved in data interpretation. MHS and MAN drafted the manuscript. All authors edited the manuscript and approved the final version.

  • Funding This study was funded by Kræftens Bekæmpelse (http://dx.doi.org/10.13039/100008363) and TrygFonden (http://dx.doi.org/10.13039/501100007437).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.