• Dachen Chu, Yung-Feng Yen, Hsiao-Yun Hu, Yun-Ju Lai, Wen-Jung Sun, Ming-Chung Ko, Li-Ying Huang, Chu-Chieh Chen, Curtis J Randall JR Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington., Ya-Ling Lee, and Sheng-Jean Huang.
• Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan.
• Plos One. 2018 Jan 1; 13 (7): e0197552.

BackgroundAlthough advance directives (AD) have been implemented for years in western countries, the concept of AD is not promoted extensively in eastern countries. In this study we evaluate a program to systematically conduct advance care planning (ACP) communication for hospitalized patients in Taiwan and identify the factors associated with AD completion.MethodsIn this retrospective evaluation of a clinical ACP program, we identified adult patients with chronic life-limiting illness admitted to Taipei City Hospital between April 2015 and January 2016. Trained healthcare providers held an ACP meeting to discuss patients' preference regarding end-of-life care and AD completion. A multiple logistic regression was performed to determine the factors associated with the AD completion.ResultsA total of 2878 patients were determined to be eligible for ACP during the study, among which 1798 (62.5%) completed ACP and data was available for 1411 patients (49.1%). Of the 1411 patients who received ACP communication with complete data, the rate of AD completion was 82.6%. The overall mean (SD) age was 78.2 (14.4) years. Adjusting for other variables, AD completion was associated with patients aged ≥ 85 years [adjusted odds ratio (AOR) = 1.80, 95% CI 1.21-2.67], critical illness (AOR = 1.17, 95% CI 1.06-1.30), and social workers participating in ACP meetings (AOR = 1.74, 95% CI 1.24-2.45).ConclusionThe majority of inpatients with chronic life-limiting illness had ACP communication as part of this ACP program and over 80% completed an AD. Our study demonstrates the feasibility of implementing ACP discussion in East Asia and suggests that social workers may be an important component of ACP communication with patients.

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