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Research Letter
March 2, 2020

Patterns and Trends in Advance Care Planning Among Older Adults Who Received Intensive Care at the End of Life

Author Affiliations
  • 1Pulmonary, Critical Care, Allergy, and Sleep Medicine Program, Department of Medicine, University of California, San Francisco
  • 2Division of Geriatrics, Department of Medicine, University of California, San Francisco
  • 3San Francisco Veterans Affairs Medical Center, San Francisco, California
  • 4Department of Anesthesia, University of California, San Francisco
  • 5Cardiovascular Research Institute, University of California, San Francisco
JAMA Intern Med. Published online March 2, 2020. doi:10.1001/jamainternmed.2019.7535

Approximately 30% of adults older than 65 years are treated in an intensive care unit (ICU) during the last month of life.1 Advance care planning (ACP)—a process that involves documenting wishes in an advance directive, appointing a surrogate decision maker, and having conversations about values, goals, and preferences2—can give such persons more control over their care.3 By contrast, those without ACP risk receiving unwanted, high-intensity, lower-quality care.4 This can lead to individual harms, including pain and suffering, and family harms, including psychosocial and financial distress.5 We therefore examined ACP completion among older adults treated in an ICU during their last month of life to determine the prevalence and factors associated with no ACP.

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