Advance Care Planning for Patients With Substance Use Disorder

Area of Science:

• Medical research
• Public health
• Health services research

Background:

• Patients with substance use disorder (SUD) face higher mortality and altered decision-making capacity.
• Advance care planning (ACP) use in SUD populations is understudied.

Purpose of the Study:

• To determine the rate of ACP completion in patients diagnosed with SUD.
• To identify variables associated with ACP completion in patients with SUD.

Main Methods:

• Retrospective review of electronic health records (EHRs) for patients with and without SUD diagnoses (August 2011-December 2019).
• Advance directives (ADs) in EHRs indicated ACP.
• Propensity-matched cohorts (SUD vs. no SUD) were compared using statistical methods.

Main Results:

• Patients with SUD showed a significantly higher unadjusted rate of ADs (9.9% vs. 0.7%, P<0.001) compared to patients without SUD.
• SUD patients had higher baseline Charlson Comorbidity Index (CCI) scores, greater Medicaid/Medicare payor status, and more healthcare encounters.
• The difference in AD rates persisted after adjusting for baseline differences.

Conclusions:

• Patients with SUD diagnoses were more likely to have an AD in their EHR than those without.
• SUD patients had higher CCI scores, more healthcare encounters, and a higher death rate.
• Further research is needed to improve communication and documentation of healthcare preferences for the SUD population.