Improving Advance Care Planning in Outpatients with Decompensated Cirrhosis: A Pilot Study: Advance Care Planning in Patients with Decompensated Cirrhosis.

Abstract

BACKGROUND\nDespite significant morbidity and mortality among patients with decompensated cirrhosis (DC), reported rates of advance directive (AD) completion and goals of care discussions (GCD) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention.\n\n\nMEASURES\nRates of AD and GCD completion, as well as self-reported barriers to ACP.\n\n\nINTERVENTION\nProvider-led ACP in patients with DC without a prior documented AD.\n\n\nOUTCOMES\nSixty-two patients were seen over 115 clinic visits. After the intervention, AD completion rates increased from 8 to 31% and GCD completion rates rose from 0 to 51%. Women (p=0.048) and non-married adults (p=0.01) had greater changes in AD completion compared to men and married adults, respectively. Needing more time during visits was seen as the major barrier to ACP among providers.\n\n\nCONCLUSIONS/LESSONS LEARNED\nAddressing provider and system-specific barriers dramatically improved documentation rates of ACP.