Qualitative Analysis of Community Dwelling Older Adults’ Advance Care Planning Interviews: Patients Want a Chance

BackgroundOlder adults living with serious illnesses face challenging decisions with illness progression. Advance Care Planning (ACP) presents an opportunity to explore values and goals, absent the pressure of time-sensitive decisions.ParticipantsCommunity-dwelling adults ≥65 with an estimated 33% mortality risk, and if invited by the participant, the person who would serve as their surrogate decision maker (SDM).SettingPrimary care practices in a Midwest metro area. Interviews occurred in the patient's home or other preferred location.MethodsQualitative, descriptive study analyzing ACP conversations that used the Respecting Choices Advanced Steps (RCAS) framework, which includes the opportunity to complete an Indiana POST form. Interviews were conducted at baseline and 1 year later. Interviews were digitally recorded, transcribed, and then analyzed using an inductive content analysis approach.FindingsParticipants included 22 patients and 8 potential surrogates. Themes included reasons for ACP, living well, and impact of serious illness. When expressing preferences for future treatment, many participants selected limited interventions until they realized this did not include cardiopulmonary resuscitation. After learning this, participants often selected full intervention and full code because they wanted a chance to re-establish an acceptable quality of life.ConclusionSome older adults with a high mortality risk desire resuscitation and ICU care because they want a chance at getting back to a preferred state of living well. If a patient survives these interventions, SDMs are likely to encounter decisions about whether further life-sustaining treatment can achieve a patient's goals and values and their perspectives on what living well means.