Researchers dissect end-of-life care practices, issue best practices

Making sure that residents' care preferences are consistently recorded and updated in medical records is crucial to providing quality end-of-life care, researchers stress in a recently published report.

Advanced care planning is an important step for patients and families to take, especially at a time when nearly a quarter of hospitalized older adults are not able to make their own end-of-life decisions. That's according to a team of researchers from the Regenstrief Institute, Indiana University Center for Aging Research and the Indiana University School of Nursing.

But inconsistencies in the way care preferences are documented and carried out by nursing homes and hospitals may mean a patient's' preferences are not honored. The team's report, published online in the Journal of Pain and Symptom Management, set out to measure care consistency with documented care practices, and how healthcare providers can improve that consistency.

"This paper delves into an issue important to both patients and providers--consistency with documented care preferences,” said lead researcher Kathleen Unroe, M.D., MHA, in a release published Monday. “We investigated the practicality of implementation of quality metrics to measure consistency of care with advance care planning and what barriers exist to putting these metrics into practice."

Unroe and her team recommend five best practices for providers to ensure consistency with their residents care preferences:

  • Documenting each resident's specific treatment preferences, such as “do not place feeding tube” instead of “comfort care,” in the medical record

  • Making sure treatment preferences are recorded in a consistent format and location in each medical record

  • Reviewing and updating preferences regularly as residents' clinical conditions change

  • Creating data collection strategies to document decisions to withhold medical interventions

  • Implementing a consistent measurement approach, such as a required percentage for agreement with care preferences, that can be used to compare with other providers

"Advance care planning is a process, not just a form," said report co-author Alexia Torke, M.D. “It is important that when a person faces serious illness and can no longer make decisions, the care they receive is consistent with the wishes they have previously expressed."