A randomized, controlled trial of advance care planning discussions duringpreoperative evaluations

Background Although many patients and physicians support the concept of adv ance care planning, only a small percentage of patients actually have the n ecessary discussion with health care providers. Hospital-based physicians o ther than primary care providers often are needed to increase physician, pa tient, and proxy communication about advanced directives. This study evalua ted the effectiveness of a 5-10-min discussion designed to foster dialogue between patients and their proxies In a preoperative evaluation clinic. The discussions were lead by anesthesiologists. Methods: A randomized controlled trial was conducted from September 1998 th rough May 1999 in a preoperative evaluation clinic at University of Califor nia, San Francisco, a tertiary care center. English-speaking patients aged 65 yr or older who were scheduled for elective surgery were randomized to r eceive a short information session stressing the importance of communicatio n about end-of-life care between the patients, and their proxies. Patients randomized to the control group received the standard preoperative anesthes ia screening. An admitting counselor questioned all patients (control and i ntervention) about whether they have an advanced directive as part of the r egistration process before their arrival in clinic. Results The intervention significantly increased discussions about end-of-l ife care between patients and their proxies. Eighty seven percent of patien ts reported having discussions with their proxies as compared with only 66% of control patients (P = 0.001). The intervention also increased durable p ower of attorney completion rate to 27% as compared with 10% completion rat e by controls. Conclusions The preoperative evaluation period can be an opportunity to enc ourage patient and proxy communication about end-of-life care.