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Medical records often don’t include EOL care plans


Communication often does not take place between healthcare providers and elderly patients facing end-of-life care questions, according to a Canadian study.

Daren K. Heyland, MD, MSc, of Kingston General Hospital in Ontario, and colleagues examined elderly patients’ advance care planning activities before hospitalization and preferences for care from the perspectives of patients and family members.

A total of 278 elderly patients who were at high risk of dying in the next six months and 225 family members participated in the in-person administered questionnaire at 12 acute care hospitals in Canada between September 2011 and March 2012.

Before hospitalization, 76.3% of patients had thought about EOL care, with 11.9% of those preferring life-prolonging care, 47.9% having completed an advance care plan and 73.3% having formally named a surrogate decision-maker for healthcare.

Of patients who had discussed their wishes, 30.3% had done so with the family physician and 55.3% with any member of the healthcare team.

Notably, agreement between patients’ expressed preferences for EOL care and documentation in the medical record was only 30.2%. Family members’ perspectives were similar to those of patients.

“For the most part, these patients and their family members have considered their wishes for medical treatments at the EOL, but there has been very little communication with healthcare professionals (either before or during hospitalization) and inadequate documentation of these wishes,” the authors wrote.

The study was published April 1 on the website of JAMA Internal Medicine (formerly the Archives of Internal Medicine). The study abstract is available at


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