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Describe frequency and quality of ACP documentation among patients with confirmed or suspected COVID-19.
Recognize palliative care consultation is associated with increased ACP documentation.
Original Research Background
Advanced care planning (ACP) supports individuals in understanding and expressing their personal values for medical care in times of serious illness. (1) The COVID-19 pandemic has increased the urgency of ACP discussions, as those infected have high rates of ICU admission, mechanical ventilation, and increased mortality. (2) No prior research has studied the frequency, quality, and factors associated with ACP documentation among patients suspected of having COVID-19.
We assessed the frequency and quality of ACP documentation in hospitalized patients positive for COVID-19 compared with those who tested negative.
We conducted structured chart reviews on all adults tested for COVID-19 who were admitted to a 600-bed academic tertiary care center in San Francisco, CA between March 1–31, 2020. Multivariate logistic regression was performed to identify factors associated with ACP documentation.
29 patients were diagnosed with COVID-19, while 229 patients tested negative. Demographic data was statistically similar between the two groups. 37.9% of patients with COVID-19 had documentation in a centralized ACP navigator in the EMR, compared to 46.3% of COVID-negative patients (p=0.43). ACP documentation for COVID-19 patients centered around code status (n=11, 100%), rather than prognosis (n=0, 0%) or other wishes (n=3, 27%). For all patients, palliative care consultation was associated with significantly higher odds of ACP documentation (OR 11.51, CI 2.92-77.35, p=0.002).
Conclusion and Implications for Research, Policy, or Practice
Hospitalized patients with COVID-19 had low rates of ACP documentation, albeit similar to those testing negative. While future studies are needed to explore underlying factors, proposed explanations include PPE requirements, visitor restrictions, clinical uncertainty regarding prognosis, and racial and ethnic disparities. Palliative care consultation was associated with increased ACP documentation across all patients. These findings highlight the importance of palliative care involvement in the care of patients with COVID-19 to ensure timely ACP discussions.