Physician Use of Advance Care Planning Discussions in a Diverse Hospitalized Population

Among a sample of minority hospital patients, less than half had an advance care discussion with a physician.

The Patient Self Determination Act was passed to ensure more patient involvement in advance care planning discussions. The act guarantees the right of a patient to provide an advance directive; instructions for care given if the patient becomes incapacitated. However, a majority of patients do not participate in advance care planning. Ethnic minority patients are less involved in advance care planning than White patients. This study, conducted among patients with limited English proficiency, investigated which patients at two hospitals had advance planning discussions.

The study took place between 2005 and 2008 at two urban hospitals—a safety net hospital with a mostly African-American and Latino population and an academic medical center serving many Chinese- speaking patients. Researchers conducted interviews at baseline and two weeks after patients were discharged; interviews obtained demographic information and addressed the nature of advance care planning discussions with hospital staff. Researchers created comorbidity scores based on patient responses to the Self-Administered Comorbidity Questionnaire.

Key Findings:

  • Only 41 percent of patients reported having an advance care discussion with a physician during hospitalization.
  • Patients who had an advance care discussion had more comorbidities.
  • Ability to speak English did not affect the likelihood that a patient had an advance care discussion.

Advance care planning is a complex process that requires discussions between patients and physicians. This article reports on an investigation of factors associated with patients and physicians engaging in advance care discussions.