• Arpan Patel, Nina Kogekar, Ritu Agarwal, Cynthia Cohen, James Phillip Esteban, Kamron Pourmand, Eugenia Tsai, Alyson Harty, Andre Pelham-Braithwaite, Ponni Perumalswami, Douglas Dieterich, and Thomas Schiano.
• Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Division of Gastroenterology and Hepatology, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California, USA. Electronic address: apatel1488@gmail.com.
• J Pain Symptom Manage. 2020 Apr 1; 59 (4): 864-870.

BackgroundDespite significant morbidity and mortality among patients with decompensated cirrhosis, reported rates of advance directive (AD) completion and goals of care discussions (GCDs) between patients and providers are very low. We aimed to improve these rates by implementing a hepatologist-led advance care planning (ACP) intervention.MeasuresRates of AD and GCD completion, as well as self-reported barriers to ACP.InterventionProvider-led ACP in patients with decompensated cirrhosis without a prior documented AD.OutcomesSixty-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 nonmarried 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.Conclusions/Lessons LearnedAddressing provider and system-specific barriers dramatically improved documentation rates of ACP.Published by Elsevier Inc.

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