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Completion of Advance Directives and Documented Care Preferences During the Coronavirus Disease 2019 (COVID-19) Pandemic

Educational Objective
To understand the importance of patients completing advance directives and provided documented care preferences during COVID-19
1 Credit CME

Fewer than one-third of US residents have completed an advance directive (AD) to guide care when seriously ill.1 Clinician-focused efforts to increase AD completion, such as Medicare payments for advance care planning (ACP), have been ineffective.2 In contrast, patient-facing interventions that enable independent completion of ADs show early promise.3 Self-service platforms also reveal changes in demand for ADs and preferences for future care. We sought to quantify changes in patient completion of ADs and expressed preferences during the coronavirus disease 2019 (COVID-19) pandemic by monitoring users of a web-based AD platform from January 2019 to April 2020.

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Article Information

Accepted for Publication: June 11, 2020.

Published: July 20, 2020. doi:10.1001/jamanetworkopen.2020.15762

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Auriemma CL et al. JAMA Network Open.

Corresponding Author: Catherine L. Auriemma, MD, Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, 300 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19103 (Catherine.auriemma@pennmedicine.upenn.edu).

Author Contributions: Dr Auriemma had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Halpern, J. M. Asch, Van Der Tuyn, D. A. Asch.

Acquisition, analysis, or interpretation of data: Auriemma, J. M. Asch, Van Der Tuyn.

Drafting of the manuscript: Auriemma, Halpern, Van Der Tuyn, D. A. Asch.

Critical revision of the manuscript for important intellectual content: Auriemma, Halpern, J. M. Asch, D. A. Asch.

Statistical analysis: Auriemma, Halpern, J. M. Asch.

Administrative, technical, or material support: Van Der Tuyn.

Supervision: Halpern.

Conflict of Interest Disclosures: None reported.

Funding/Support: Financial support for this study was provided by The Palliative and Advanced Illness Research (PAIR) Center and the Center for Health Care Innovation, both at the University of Pennsylvania. Dr Auriemma is supported by training grant 5T32HL098054-09 from the National Heart, Lung, and Blood Institute.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Yadav  KN , Gabler  NB , Cooney  E ,  et al.  Approximately one in three US adults completes any type of advance directive for end-of-life care.   Health Aff (Millwood). 2017;36(7):1244-1251. doi:10.1377/hlthaff.2017.0175PubMedGoogle ScholarCrossref
2.
Ashana  DC , Halpern  SD , Umscheid  CA , Kerlin  MP , Harhay  MO .  Use of advance care planning billing codes in a retrospective cohort of privately insured patients.   J Gen Intern Med. 2019;34(11):2307-2309. doi:10.1007/s11606-019-05132-1PubMedGoogle ScholarCrossref
3.
Sudore  RL , Schillinger  D , Katen  MT ,  et al.  Engaging diverse English- and Spanish-speaking older adults in advance care planning: the PREPARE randomized clinical trial.   JAMA Intern Med. 2018;178(12):1616-1625. doi:10.1001/jamainternmed.2018.4657PubMedGoogle ScholarCrossref
4.
Block  BL , Smith  AK , Sudore  RL .  During COVID-19, outpatient advance care planning is imperative: we need all hands on deck.   J Am Geriatr Soc. Published May 2, 2020. doi:10.1111/jgs.16532PubMedGoogle Scholar
5.
Curtis  JR , Kross  EK , Stapleton  RD .  The importance of addressing advance care planning and decisions about do-not-resuscitate orders during novel coronavirus 2019 (COVID-19).   JAMA. 2020;323(18):1771-1772. doi:10.1001/jama.2020.4894PubMedGoogle Scholar
6.
Halpern  SD .  Shaping end-of-life care: behavioral economics and advance directives.   Semin Respir Crit Care Med. 2012;33(4):393-400. doi:10.1055/s-0032-1322403PubMedGoogle ScholarCrossref
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