Advance Care Planning for Patients With Substance Use Disorder

Patients with substance use disorder (SUD) have a higher risk of mortality and changes in medical decision-making capacity than patients in the general population. However, little is known about their use of advance care planning (ACP). Our aim was to determine the rate of, and variables associated with ACP completion in patients with an SUD diagnosis.

The electronic health records (EHRs) of all patients with an SUD diagnosis from August 2011 through December 2019 were retrospectively reviewed to determine their rate of ACP compared with that of patients without an SUD diagnosis. The presence of an advance directive (AD) in the EHR indicated ACP. Retrospectively matched cohorts, SUD and no SUD, were compared using unadjusted and adjusted statistical methods.

Two thousand four hundred forty-four individuals with SUD were identified and propensity-matched with 4888 patients. Patients with SUD had a significantly greater unadjusted rate of ADs (9.9% vs 0.7%, P<0.001) than that of patients with no SUD. Patients with SUD had slightly higher baseline Charlson Comorbidity Index (CCI) scores, a higher rate of Medicaid/Medicare payor status, and higher rates of health care encounters per year. Significant difference in the rate of ADs persisted after adjusting for noted baseline differences in patients with and without SUD.

Patients with SUD diagnoses were more likely to have an AD in their EHR than those without. Patients with an SUD diagnosis also had slightly higher CCI scores at baseline, more health care system encounters, and a higher death rate during the study period. Our population was relatively younger than the age at which people typically complete ADs. Further study is warranted to support appropriate communication and documentation regarding this population's health care preferences.