SAN FRANCISCO – .
Doug Brunk/MDedge Medical News
Dr. Connie W. Wang
“Recent studies have shown that there have been low rates of these types of discussions in all areas of medicine, not just in liver transplantation per se,” Connie W. Wang, MD, said in an interview at the annual meeting of the American Association for the Study of Liver Diseases. “We were curious to see what it looked like in our practice setting.”
In an effort to evaluate current advanced care planning documentation practices in the liver transplantation setting, she and her colleagues reviewed the medical charts of 168 adults who underwent an initial liver transplant evaluation at the University of California, San Francisco, from January 2017 to June 2017. Next, to assess readiness to complete advanced care planning among liver transplant candidates, the researchers administered the Advanced Care Planning Engagement Survey to 41 adults who underwent an initial liver transplant evaluation from March 2018 to May 2018. The survey was scored on a Likert scale of 1-4, in which a score of 4 equaled “ready” or “confident,” and a score of 5 equaled “very ready” or “very confident.”
The mean age of the 168 transplant candidates was 53 years, 35% were female, and 52% were non-Hispanic white. Only 15 patients (9%) reported completing advanced care planning prior to their liver transplant evaluation and none had legal advance care planning forms scanned or end-of-life wishes documented in the medical record. Durable power of attorney for health care was discussed with 17 patients (10%). On logistic regression analysis, only white race was associated with completion of advanced care planning (OR 4.16; P = .03), but age, Child-Pugh score, and MELD-Na score were not.
The mean age of the 41 transplant candidates who completed the Advanced Care Planning Engagement Survey was 58 years, 39% were female, and 58% were non-Hispanic white. Nearly all respondents (93%) indicated that they were ready to appoint a durable power of attorney, 85% were ready to discuss end-of-life care, and 93% were ready to ask physicians questions about medical decisions. Similarly, 93% of patients felt confident to appoint a durable power of attorney, 88% felt confident to discuss end-of-life care, and 93% felt confident to ask physicians questions about medical decisions.
“It seems like from the patients’ perspective, they are very much open to having these conversations, but there hasn’t been [the right] environment or setting to have them,” said Dr. Wang, a third-year internal medicine resident at UCSF. “Or, there may be a barrier from the provider’s perspective. Clearly, there is a huge need that can be filled.” She noted that future research should focus on development of tools to facilitate discussions and documentation between transplant clinicians, patients, and their caregivers.
One of the study authors, Jennifer C. Lai, MD, reported being a consultant for Third Rock Ventures, LLC. The other researchers reported having no financial disclosures.
Source: Hepatol. 2018;68[S1]: Abstract 771.
