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Advance care planning may be linked to longer survival

Terminally ill patients who share preferences for their end-of-life care may survive longer

Ingrid Torjesen

Wednesday, 11 December 2019

Sharing preferences for end-of-life care, known as advance care planning, may be linked to longer survival in terminally ill patients, suggests a study*, published online in the journal BMJ Supportive & Palliative Care.

Advance care planning enables adults to discuss wishes and priorities for their care, including stopping life prolonging treatment, but it has been unclear what impact this might have on survival in patients who are terminally ill.

The researchers used data from a previously published randomised controlled trial, which aimed to find out if advance care planning had any impact on meeting terminally ill patients' preferences for place of death.

That study tracked the date of death for 205 terminally ill patients, 102 of whom had had a conversation about their preferences for end-of-life care with a doctor, and 103 of who had not. Around half the patients in each of the groups had advance cancer, and half had heart and lung conditions.

Further analysis of these data showed that there was a difference in survival after a year of monitoring between those who had had a conversation about their end-of-life preferences with their doctor and those who had not.

Nearly three out of four of those (73%) of those who had had such a conversation were alive after a year compared with 57% of those who hadn't.

While there was no significant difference in survival between terminally ill cancer patients who had and hadn't had an advance care planning conversation, there was between those with other types of terminal illness, the analysis showed.

Among this group, nine out of 10 (90%) of those who had done so were alive after a year, compared with two thirds (67%) of those who had not.

The researchers suggest that an advance care planning conversation helps these patients better understand the life-limiting nature of their illness. This may change their views about having treatment that prolongs life, such as steroids, which, paradoxically, have been associated with a heightened risk of death and other illness - at least among those with serious lung disease, they said.

"[Advance care planning] was associated with a significantly improved survival among terminally ill patients, primarily [those] with non-cancer diseases. However, the analysis was explorative, and the association must be investigated further before drawing any firm conclusion," the researchers concluded.

*Neergaard MA, Skorstengaard MH, Brogaard T, et al. Advance care planning and longer survival in the terminally ill: a randomised controlled trial unexpected finding. BMJ Supportive & Palliative Care Published Online First: 10 December 2019. doi: 10.1136/bmjspcare-2019-001906

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