Advance Directives and Palliative Care Consultation Among Older Patients in a Rural ICU
Kaitlyn Thomas, Jon C RittenbergerAbstract
Introduction:
Advance care planning (ACP) allows patients to delineate their goals of care in the event of a critical illness state where they cannot provide direct input on their care. Prior literature shows that only 37% of adults have ACP documents. We hypothesized that most patients admitted to our intensive care unit (ICU) do not have an ACP prior to hospitalization.
Methods:
We conducted a retrospective chart review of patients aged >65 years admitted to Robert Packer Hospital ICU. We recorded admitting service line, presence of an ACP on ICU admission, and consultation to palliative care. We included index ICU admissions between June 26, 2023, and November 10, 2024. Chi-square analysis was used to compare rates of ACP documentation and palliative care consultation between service lines.
Results:
We included 1,826 ICU admissions. Average age was 76 (SD 7.62) years. ACP documentation was present in 36% of patients prior to admission and differed between service lines (χ
2
= 46.8793,
Discussion:
We demonstrate a low rate of ACP documentation and palliative care consultation in patients aged >65 years admitted to our ICU. Future studies should explore the effectiveness of primary care and hospitalist initiatives in improving ACP rates in both inpatient and outpatient settings.
Conclusion:
We found low rates of ACP documentation at our rural health system.