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Use of a values inventory as a discussion aid about end-of-life care: A pilot randomized controlled trial

Published online by Cambridge University Press:  13 October 2015

Shailaja Menon ,
Laurence B. McCullough ,
Rebecca J. Beyth ,
Marvella E. Ford ,
Donna Espadas  and
Ursula K. Braun
Shailaja Menon*
Affiliation:
VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
Laurence B. McCullough
Affiliation:
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
Rebecca J. Beyth
Affiliation:
Geriatric Research Education Clinical Center, North Florida/South Georgia Veterans Health System, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
Marvella E. Ford
Affiliation:
Department of Public Health Sciences and Cancer Disparities, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
Donna Espadas
Affiliation:
VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
Ursula K. Braun
Affiliation:
VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Geriatrics, Department of Medicine, Baylor College of Medicine, Houston, Texas
*
Address correspondence and reprint request to Shailaja Menon, VA Medical Center (152), 2002 Holcombe Boulevard, Houston, Texas 77030. E-mail: smenon@bcm.edu.
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Abstract

Objective:

We examined the utility of a brief values inventory as a discussion aid to elicit patients' values and goals for end-of-life (EoL) care during audiotaped outpatient physician–patient encounters.

Method:

Participants were seriously ill male outpatients (n = 120) at a large urban Veterans Affairs medical center. We conducted a pilot randomized controlled trial, randomizing 60 patients to either the intervention (with the values inventory) or usual care. We used descriptive statistics and qualitative methods to analyze the data. We coded any EoL discussions and recorded the length of such discussions.

Results:

A total of 8 patients (13%) in the control group and 13 (23%) in the intervention group had EoL discussions with a physician (p = 0.77). All EoL discussions in the control group were initiated by the physician, compared with only five (38%) in the intervention group. Because most EoL discussions took place toward the end of the encounter, discussions were usually brief.

Significance of results:

The outpatient setting has been promoted as a better place for discussing EoL care than a hospital during an acute hospitalization for a chronic serious illness. However, the low effectiveness of our intervention calls into question the feasibility of discussing EoL care during a single outpatient visit. Allowing extra time or an extra visit for EoL discussions might increase the efficacy of advance care planning.

Keywords

Advance care planningTerminal careRandomized controlled trialVeteransOutpatientsAmbulatory care
Type
Original Articles
Information
Palliative & Supportive Care , Volume 14 , Issue 4 , August 2016 , pp. 330 - 340
Copyright
Copyright © Cambridge University Press 2015 

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