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Increasing Advance Care Planning Using a Surgical Optimization Program for Older Adults.

Anna Kata1, Rebecca Sudore1,2, Emily Finlayson1,3

  • 1Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.

Journal of the American Geriatrics Society
|October 6, 2018
PubMed
Summary
This summary is machine-generated.

The Surgery Wellness Program (SWP) significantly increased advance care planning (ACP) engagement in older adults undergoing surgery. This innovative preoperative care model improved surrogate designation and advance directive completion, enhancing patient care.

Keywords:
advance care planningadvance directivegeriatric surgeryolder adultpreoperative period

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Area of Science:

  • Geriatrics
  • Surgical Care
  • Health Services Research

Background:

  • Older adults undergoing surgery often have complex needs.
  • Advance care planning (ACP) is crucial for this population but frequently overlooked in preoperative settings.
  • Innovative care models are needed to integrate ACP into surgical pathways.

Purpose of the Study:

  • To describe the Surgery Wellness Program (SWP), a multidisciplinary preoperative care model for older adults.
  • To evaluate the impact of the SWP on patient engagement in advance care planning (ACP).

Main Methods:

  • Retrospective analysis of a clinical demonstration project involving 131 older adults.
  • SWP utilized geriatricians for ACP discussions and health coaches (medical/nurse practitioner students) for regular follow-up.
  • ACP engagement was assessed via progress notes and medical record review.

Main Results:

  • Significant increases observed in designated surrogate (67% to 78%) and completed advance directives (51% to 72%).
  • Proportion of advance directives scanned into medical records rose from 14% to 60%.
  • Participants received a median of 4 health coaching calls over 27 days.

Conclusions:

  • Preoperative optimization programs offer a valuable opportunity to enhance ACP in older surgical patients.
  • The SWP model demonstrates feasibility and effectiveness in improving ACP engagement.
  • Integrating ACP into surgical care pathways is essential for comprehensive geriatric care.