• Carolyn E Schwartz, H Brownell Wheeler, Bernard Hammes, Noreen Basque, Jean Edmunds, George Reed, Yunsheng Ma, Lynn Li, Patricia Tabloski, Julianne Yanko, and UMass End-of-Life Working Group.
• Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA 01742, USA. carolyn.schwartz@umassmed.edu
• Arch Intern Med. 2002 Jul 22;162(14):1611-8.

BackgroundA large discrepancy exists between the wishes of dying patients and their actual end-of-life care. However, retrospective clinical experience suggests that early advance care planning (ACP) can markedly reduce this discrepancy. This article describes a randomized trial to evaluate the short-term clinical utility of early ACP. We also assessed the feasibility of performing a larger prospective study to document long-term outcomes.MethodsAmbulatory geriatric patients (N = 61) were randomized to either a control group, which received only a Massachusetts Health Care Proxy form to complete, or an intervention group, in which each patient and health care agent discussed ACP with a trained nurse facilitator. The benefits and burdens of life-sustaining treatments were discussed, and patient goals and preferences for these treatments were documented.ResultsTwo-month follow-up revealed that the intervention achieved higher congruence between agents and patients in their understanding of patients' end-of-life care preferences, with 76% (19/25) in complete agreement vs 55% (12/22) of the controls (effect size [ES] = -0.43). There was also a greater increase in patient knowledge about ACP in the intervention group (ES = 0.22). Intervention patients became less willing to undergo life-sustaining treatments for a new serious medical problem (ES = -0.25), more willing to undergo such treatments for an incurable progressive disease (ES = 0.24), and less willing to tolerate poor health states (ES = -0.78). Practical insights were gained about how to conduct a larger study more effectively.ConclusionA facilitated discussion about end-of-life care between patients and their health care agents helps define and document the patient's wishes for both patient and agent.

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