Connie W Wang1, Adrienne Lebsack1, Rebecca L Sudore2,3, Jennifer C Lai4. 1. Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, 513 Parnassus Avenue, UCSF Box 0538, San Francisco, CA, 94143, USA. 2. Division of Geriatrics, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA. 3. San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA. 4. Division of Gastroenterology and Hepatology, Department of Medicine, University of California-San Francisco, 513 Parnassus Avenue, UCSF Box 0538, San Francisco, CA, 94143, USA. Jennifer.Lai@ucsf.edu.
Abstract
BACKGROUND: Patients with end-stage liver disease awaiting liver transplantation (LT) are seriously ill and experience fluctuating periods of clinical decompensation. Discussion of a patient's advance care planning (ACP) wishes early in their dynamic disease course is critical to providing value-aligned care while awaiting LT. We aimed to evaluate current ACP documentation and assess readiness to engage in ACP in this population. METHODS: We conducted a retrospective study of adults undergoing LT evaluation from January 2017 to June 2017 and assessed characteristics associated with documentation using logistic regression. We then administered a survey to LT candidates from March 2018 to May 2018 to determine self-reported readiness to engage in ACP (range 1 = not at all ready to 5 = very ready). RESULTS: Among 170 LT candidates, median (interquartile range) age was 58 (53-65), 65% were men, MELDNa was 15 (11-21), and Child-Pugh A/B/C were 33/38/29%. Nine percent reported completing ACP prior to LT evaluation, but 0% had legal ACP forms or end-of-life wishes documented in the medical record. A durable power of attorney (DPOA) was discussed with 10%. In univariable analysis, white race (OR 4.16, p = 0.03) and female sex (OR 3.06, p = 0.04) were associated with ACP documentation, but Child-Pugh score and MELDNa were not. Of the 41 LT candidates who completed the ACP survey, 93% were ready to appoint a DPOA and 85% were ready to discuss end-of-life care. CONCLUSION: There is a paucity of ACP documentation and identification of DPOA among LT candidates, despite patients reporting readiness to complete ACP and appoint a DPOA. These results reveal an opportunity for tools to facilitate discussions around ACP between clinicians, patients, and their caregivers.
BACKGROUND: Patients with end-stage liver disease awaiting liver transplantation (LT) are seriously ill and experience fluctuating periods of clinical decompensation. Discussion of a patient's advance care planning (ACP) wishes early in their dynamic disease course is critical to providing value-aligned care while awaiting LT. We aimed to evaluate current ACP documentation and assess readiness to engage in ACP in this population. METHODS: We conducted a retrospective study of adults undergoing LT evaluation from January 2017 to June 2017 and assessed characteristics associated with documentation using logistic regression. We then administered a survey to LT candidates from March 2018 to May 2018 to determine self-reported readiness to engage in ACP (range 1 = not at all ready to 5 = very ready). RESULTS: Among 170 LT candidates, median (interquartile range) age was 58 (53-65), 65% were men, MELDNa was 15 (11-21), and Child-Pugh A/B/C were 33/38/29%. Nine percent reported completing ACP prior to LT evaluation, but 0% had legal ACP forms or end-of-life wishes documented in the medical record. A durable power of attorney (DPOA) was discussed with 10%. In univariable analysis, white race (OR 4.16, p = 0.03) and female sex (OR 3.06, p = 0.04) were associated with ACP documentation, but Child-Pugh score and MELDNa were not. Of the 41 LT candidates who completed the ACP survey, 93% were ready to appoint a DPOA and 85% were ready to discuss end-of-life care. CONCLUSION: There is a paucity of ACP documentation and identification of DPOA among LT candidates, despite patients reporting readiness to complete ACP and appoint a DPOA. These results reveal an opportunity for tools to facilitate discussions around ACP between clinicians, patients, and their caregivers.
Entities:
Keywords:
Advance care planning; Cirrhosis; Liver transplant; Surrogate decision maker
Authors: Judith A C Rietjens; Rebecca L Sudore; Michael Connolly; Johannes J van Delden; Margaret A Drickamer; Mirjam Droger; Agnes van der Heide; Daren K Heyland; Dirk Houttekier; Daisy J A Janssen; Luciano Orsi; Sheila Payne; Jane Seymour; Ralf J Jox; Ida J Korfage Journal: Lancet Oncol Date: 2017-09 Impact factor: 41.316
Authors: Naoka Murakami; Nathan D Baggett; Margaret L Schwarze; Keren Ladin; Andrew M Courtwright; Hilary J Goldberg; Eric P Nolley; Nelia Jain; Michael Landzberg; Kirsten Wentlandt; Jennifer C Lai; Myrick C Shinall; Nneka N Ufere; Christopher A Jones; Joshua R Lakin Journal: J Palliat Med Date: 2022-03-11 Impact factor: 2.947