• Shih-Chieh Lee, Chih-Yuan Shih, Shan-Ting Chen, Ching-Yi Lee, Shin-Rung Li, Chia-Chun Tang, Jaw-Shiun Tsai, Shao-Yi Cheng, and Hsien-Liang Huang.
• Department of Family Medicine (S.-C.L.), Fu Jen Catholic University Hospital, No. 69, Guizi Road, Taishan District, New Taipei City, Taiwan.
• J Pain Symptom Manage. 2024 Jun 1; 67 (6): 544553544-553.

ContextDespite making do-not-resuscitate or comfort care decisions during advance care planning, terminally ill patients sometimes receive life-sustaining treatments as they approach end of life.ObjectivesTo examine factors contributing to nonconcordance between end-of-life care and advance care planning.MethodsIn this longitudinal retrospective cohort study, terminally ill patients with a life expectancy shorter than six months, who had previously expressed a preference for do-not-resuscitate or comfort care, were followed up after palliative shared care intervention. An instrument with eight items contributing to non-concordant care, developed through literature review and experts' consensus, was employed. An expert panel reviewed electronic medical records to determine factors associated with non-concordant care for each patient. Statistical analysis, including descriptive statistics and the chi-square test, examines demographic characteristics, and associations.ResultsAmong the enrolled 7871 patients, 97 (1.2%) received non-concordant care. The most prevalent factor was "families being too distressed about the patient's deteriorating condition and therefore being unable to let go" (84.5%) followed by "limited understanding of medical interventions among patients and surrogates" (38.1%), and "lack of patient participation in the decision-making process" (25.8%).ConclusionsThis study reveals that factors related to relational autonomy, emotional support, and health literacy may contribute to non-concordance between advance care planning and end-of-life care. In the future, developing an advance care planning model emphasizes respecting relational autonomy, providing emotional support, and enhancing health literacy could help patients receiving a goal concordant and holistic end-of-life care.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

18 keywords...

hide…