When death is imminent - documenting end-of-life decisions

There has been widespread promotion of advance care planning in recent years, which is consistent with an ageing population and a greater awareness of patient self determination.

A review of medical records relating to hospital patient deaths and a separate review of emergency department admissions of patients aged 75 years or more in the same hospital.

In the patient deaths sample, 77% of patients (median age 79 years), had their first documented end-of-life discussion 3 days before death. In the sample of emergency department admissions, 82% of patients (median age 83 years), had no documented end-of-life discussion or review by the time of discharge. Only two patients, both in the emergency department admissions group, had written advance care plans before admission.

This study suggests that documented advance care plans are either not being prepared in the community or are not being communicated to acute care facilities. As a result, end-of-life care preferences are documented when death is imminent.