CROSS SECTIONAL SURVEY ON ADVANCE CARE PLANNING ACCEPTANCE AND END OF LIFE CARE PREFERENCES AMONG COMMUNITY DWELLING ELDERLY WITH COMPLEX MEDICAL PROBLEMS AND THEIR CARERS
Authors: Tsang M L , Yeung K M , Wong Kenny , Lam P T 
Published: April 2013

Background

Advance care planning is a useful tool to facilitate families and healthcare providers to understand patient's value system, and to make decision on patient's behalf on the care that considered appropriate when one cannot make decisions.

Summary of patient and carers reply (in percentage)Strongly DisagreeDisagreeAgreeStrongly AgreeUncertainCare process I want nature to guide my life  Patient's response4.75.547.741.40.8  Carer view1.08.069.0.22.0 I do NOT want to be fed artificially by tube  Patient's response9.416.446.926.60.8  Carer view6.039.041.010.03.0 I want to be free of pain even if the treatment may make me drowsy because of its side effects  Patient's response5.515.650.827.30.8  Carer view1.02.073.024.0 I do NOT want to be intubated and given external cardiac message (CPR) if I have stop breathing and heart beat  Patient's response10.228.939.821.1  Carer view8.052.029.010.01.0 I do not want to be intubated for breathing if I cannot breath sufficiently to sustain the life  Patient's response9.426.642.221.10.8  Carer view9.048.034.07.02.0 I want to be given repeated courses of antibiotics for infection despite no improvement noted  Patient's response13.335.938.310.91.6  Carer view7.030.057.05.01.0Decision making process I want my doctor(s) to make all decisions  Patient's response2.313.353.929.70.8  Carer view8.017.060.015.0 I want my family to make all decisions for me  Patient's response10.935.946.16.30.8  Carer view6.053.038.03.0 I want to make decision by myself  Patient's response4.722.753.918.00.8  Carer view2.029.058.011.0 I want to make conjoint decision with my family  Patient's response4.726.653.115.6  Carer view3.016.057.024.0Respond to hypothetical conditions1)I have dementia and currently need major assistance in self care, cannot verbally communicate and eats very little/does not eat. I prefer:patientcarerto be fed by a tube that needs to be changed every 1–4 weeks, and my hands may need to be tied to prevent me from pulling it7.011.0to continue with small oral feed even if I may progressive lost weight and weaker93.087.0Uncertain2.02)I have chronic lung disease and have shortness of breath even with feeding. To reduce the shortness of breath, I preferpatientcarerto use a ventilator through face mask all day even if you pulled it off yourself when medical team had used it to rescue you27.336to use oral medication even if there may have possible risks/side effects that make me drowsy72.7643)I have chronic lung disease and have shortness of breath even with feeding. To reduce the shortness of breath, I preferpatientcarerto use a ventilator through face mask all day even if you pulled it off yourself when medical team had used it to rescue you27.336to use oral medication even if there may have possible risks/side effects that make me drowsy72.764Preference on advance care planningOverall, do you wish your medical doctor to discuss with you on these treatment options when you are approaching an advanced stage of disease but not acutely ill?patientcarerDiscuss with me (patient)only21.19.1Discuss with me and my relative together57.070.7Not to discuss at all, doctor make decision12.58.1Discuss with relative only9.412.1

Advanced Directive (AD), has been in place in HK for more than 10 years, is one of the means to address advance care planning. Two local studies were done among institutionalised older persons on their preference on AD. Little is known on the preference among non-institutionalised older persons.

Aim

Primary objective is estimate preference of advance care planning acceptance among community dwelling older persons with multiple medical problems. Secondary objectives are : to estimate end of life care preference as listed and potential factors affecting their choices; whether there is difference in view of older person's choice in comparisons to their next-of-kid

Methods

A Multi-centre, cross sectional survey using a structured, interviewer administered questionnaire.

Older persons with age >6, fulfilling the inclusion criteria, who attend Geriatric out-patient clinic or Day Hospital in the study period, and their paired next-of-kin are invited to participate.

Results

4 out of 7 centres have preliminary results available (see table)

Discussion

High acceptance of advance care planning in the interviewed patient (78%) and carers (79%).

Marked difference in views are observed in artificial feeding, pain management and use of antibiotic.

Conclusion

Further analysis to address the difference observed is planned. Territory wide public education and promotion on advance care planning is needed.