Advance care planning in dementia care: eliciting values from serious illness experiences (GP104)

Outcomes 1. Participants will self-report the ability to elicit and identify common values and concerns related to comfort-focused versus longevity-focused end-of-life care using serious illness experience questions as an advance care planning framework in people with dementia and their care partners.2. Participants will self-report the ability to recall differences in the relationship between serious illness experiences and end-of-life care preferences depending on severity of cognitive impairment and other factors such as cancer versus non-cancer-related experiences. Key Message Eliciting serious illness experiences from patients with dementia and their care partners is both feasible and useful for identifying value systems during advance care planning. Understanding relationships between serious illness experiences and attitudes toward comfort-focused care can help clinicians identify addressable concerns about comfort-focused and longevity-focused care. Importance People with dementia are less likely to engage in advance care planning (ACP) as compared with those with cancer or organ failure. Encouraging conversations about care goals is crucial for providing goal-concordant end-of-life care. Understanding the relationship between serious illness experience and goals of care in older adults with dementia and their care partners may enhance clinical tools for ACP. Objective(s) We analyzed how serious illness experiences related to attitudes toward comfort-focused care and if this relationship differed by cognitive impairment severity in a sample of oldest old persons with cognitive impairment (average age: 88 years) enrolled in an ACP intervention. Scientific Methods Utilized ACP conversations were recorded and transcribed for 88 primary care patients with cognitive impairment and their care partners enrolled in Sharing Healthcare Wishes in Primary Care (SHARE), an ACP intervention. We created a codebook based on the SHARE ACP facilitator guide and conducted deductive coding, followed by thematic analysis. Results Both cognitive impairment groups discussed a broad range of serious illness experiences which informed their end-of-life care goals for comfort-focused or longevity-focused care. Particularly difficult serious illness experiences such as serious disablement strengthened preferences for comfort-focused care, while experiences of prognostic errors or survival after maximal care strengthened reservations against comfort-focused care. In the severe cognitive impairment group, more serious illness experiences strengthened comfort-focused preferences (66%), whereas more serious illness experiences in the mild or moderate group strengthened reservations against comfort-focused care (66%). Conclusion(s) Serious illness experiences strongly influenced goals of care in this study. The majority of participants’ experiences strengthened their preference for comfort-focused care in the severe cognitive impairment group, while the opposite was found for the mild or moderate group. Impact Clinical tools for ACP should include eliciting serious illness experiences and discussing how they relate to the patient's values and preferences as part of goals of care conversations.