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 The authors originally set out to learn if advance care planning
influenced whether terminally-ill patients died at home or in the
hospital. But they also noticed a marked difference in how many
trial participants lived for a year or more and decided to take a
closer look.
"When we analyzed the primary data, we noticed a difference in
survival, too," said study author Mette Asbjoern Neergaard, an
associate professor at the palliative care unit, department of
oncology at Aarhus University Hospital in Denmark.
"If one advanced care planning conversation can improve survival,
that's really important to look into," she told Reuters Health over
the phone.
In advance care planning, patients are encouraged to talk about the
kind of care they want, their wishes for resuscitation or treatment
and where they prefer to die.
For their original study, Neergaard and colleagues enrolled 205
terminally-ill patients in Denmark starting in November 2013. About
half had cancer and the others had heart and lung conditions.
The researchers randomly allocated 102 patients to advance care
planning discussions about their end-of-life preferences, and 103 to
a comparison group that did not receive this intervention. All the
patients were followed until death or November 2016, the end of the
trial.
When the researchers looked at survival rates, they found that,
overall, 73% of patients who had discussed advance care planning
were alive a year after enrollment, compared with 57% of those who
did not have these discussions.
Drilling down further, they saw that among cancer patients, the
one-year survival rate was 56% with advanced care planning and 47%
without, which is too small a difference to rule out the possibility
it was due to chance.
But among patients with heart and lung conditions, 90% of patients
who had advance care planning discussions were alive at the one-year
mark compared with 67% of those who didn't get the intervention.
Neergaard said the authors don't know exactly how survival improved.
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"Having the conversation about end-of-life preferences and thoughts
may be helping patients make a commitment to life, take better care
of themselves and let their families take better care of them too,"
she said.
Discussing care options also opens pathways to symptom management
and palliative care, said Patricia Davidson, dean and professor at
Johns Hopkins School of Nursing in Baltimore, Maryland, who wasn't
involved in the study.
"We cannot underestimate the importance of patients coming to some
level of personal peace about their condition. One of the things not
often talked about is the role of existential distress," Davidson
told Reuters Health in a phone interview.
"Studies have shown palliative care is not as integrated into the
treatment of patients with non-cancer diseases," Neergaard said.
"When you have cancer, you immediately know you may die of the
disease. But when you get chronic obstructive pulmonary disease (COPD),
lung fibrosis or heart disease, you think this could be cured."
Davidson, whose key areas of interest is palliative care for heart
and lung conditions, said the current study presents compelling
evidence for the role of advance care planning, especially for
non-cancer patients, with whom prognosis is not as commonly
discussed.
Neergaard said more attention is being paid to non-cancer diseases.
"Patients often feel it should be the healthcare professional who
starts the conversation about end-of-life-care. This means care
providers must give the patient a chance to have the conversation."
SOURCE: https://bit.ly/2rDvO5z BMJ Supportive & Palliative Care,
online December 10, 2019.
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