Advance Care Planning Practice Patterns Before and During a Pandemic.

Area of Science:

• Healthcare Infrastructure
• Palliative Medicine
• Public Health Crises

Background:

• The COVID-19 pandemic prompted critical evaluation of healthcare systems, particularly advance care planning (ACP).
• Understanding ACP practices in outpatient palliative medicine (PM) is crucial, especially during public health emergencies.
• Previous research has not fully explored ACP trends during the COVID-19 pandemic in PM settings.

Purpose of the Study:

• To assess the frequency of ACP discussions and formal documentation in an outpatient palliative medicine practice before, during, and after the COVID-19 surge.
• To identify changes in ACP practices associated with the COVID-19 pandemic.
• To provide insights for optimizing ACP during health crises.

Main Methods:

• Retrospective chart review of patients in an outpatient palliative medicine clinic.
• Comparison of ACP discussion frequency and formal documentation rates between pre-COVID-19 surge (Nov 2019-Feb 2020) and during/post-COVID-19 surge (Mar-Apr 2020) periods.
• Statistical analysis, including odds ratios, to determine the likelihood of ACP discussions.

Main Results:

• Advance care planning discussions increased significantly in the post-COVID-19 surge period compared to pre-surge.
• Patients during and post-surge were more likely to discuss medical power of attorney (OR=1.78, p=0.045) and preferred code status (OR=2.82, p<0.001).
• Despite increased discussions, the creation of formal documents reflecting patient wishes for ACP was notably lacking.

Conclusions:

• The COVID-19 pandemic correlated with an increase in advance care planning conversations within an outpatient palliative medicine setting.
• While ACP discussions rose, the translation of these conversations into formal legal documents requires improvement.
• Findings can inform strategies to enhance ACP utilization and documentation during public health emergencies and in routine palliative care.