Advance Care Planning in Patients with Suspected or Proven COVID: Are We Meeting Our Own Standards?

Publication date: Nov 30, 2023

Given the importance of advance care planning (ACP) in the context of a pandemic, we aimed to assess current adherence to local policy recommending ACP in all hospitalised adult patients with suspected or proven COVID-19 at Liverpool Hospital, Sydney, Australia. A retrospective cohort study. A tertiary referral and teaching hospital. A select sample of adult patients admitted to Liverpool Hospital in 2019-2021 with suspected or proven COVID-19. Proportion of patients with documented ACP and format of ACP. Amongst 209 patients with proven or suspected COVID-19 hospitalised between March 2019 through to September 2021, median frailty score was 3, the median Charlson Comorbidity Score was 4, median age of the patients was 71 years, and median length of hospital stay was 5 days (range 0-98 days). Almost all patients were tested for COVID-19 (n = 207, 99%) of which 15% (31) were positive. Fewer than a quarter of the patients had documented ACPs (50, 24%) and 17 patients had existing formal advance care directives. Patients who had ACP were older, more likely to be frail and more likely to have higher rates of comorbidity compared to those without ACP. ACP was more commonly discussed with family members (41/50) than patients (25/50) and others (5/50). Adherence to the local ACP policy mandating such discussions was low. This reinforces the need for prioritising ACP discussions, especially for unwell patients such as those with COVID, likely involving further input to improve awareness and rates of formal documentation.

Concepts Keywords
Australia advance care planning
Liverpool COVID-19
Pandemic older people
Teaching palliative care

Semantics

Type Source Name
disease MESH COVID-19
disease MESH Comorbidity
disease MESH end of life

Original Article

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