When death is imminent: documenting end-of-life decisions

Background: There has been widespread promotion of advance care planning in recent years, which is consistent with an ageing population and a greater awareness of patient self determination. Methods: A review of medical records relating to hospital patient deaths and a separate review of emergency department admissions of patients aged 75 years or more in the same hospital. Results: In the patient deaths sample, 77% of patients (median age 79 years), had their first documented end-of-life discussion 3 days before death. In the sample of emergency department admissions, 82% of patients (median age 83 years), had no documented end-of-life discussion or review by the time of discharge. Only two patients, both in the emergency department admissions group, had written advance care plans before admission. Discussion: This study suggests that documented advance care plans are either not being prepared in the community or are not being communicated to acute care facilities. As a result, end-of-life care preferences are documented when death is imminent.