Background: Advance care planning can be challenging for both patients and providers.  Barriers to understanding patients’ goals of care include patient and provider discomfort with the topic, as well as family and cultural dynamics.  The Stanford Letter Advance Directive (LAD) is a simple tool written at a fifth grade reading level in eight different languages [...]

Background: Advance care planning can be challenging for both patients and providers.  Barriers to understanding patients’ goals of care include patient and provider discomfort with the topic, as well as family and cultural dynamics.  The Stanford Letter Advance Directive (LAD) is a simple tool written at a fifth grade reading level in eight different languages [...]

Background: Advance care planning is nationally recognized as important for honoring patient wishes at the end of life. Despite this widespread recognition, many patients lack advance care planning and spend their last days in ways not concordant with their values. Moreover, traditional advance directives may provide only a partial context for patients’ belief systems relevant [...]

Background: Hospitalists commonly discuss advance care planning (ACP), which supports patients in understanding and expressing their values for medical care during serious illness. The coronavirus disease of 2019 (COVID-19) pandemic has increased the urgency of these conversations, especially for patients with older age, comorbidities, or an otherwise high risk for complications such as ICU admission, [...]

Background: Hospitalists often care for patients with serious illness and commonly review and discuss advance care planning (ACP). Documented ACP conversations can be difficult to access in the electronic health record (EHR) due to the lack of a centralized location for ACP documentation and individual clinician practice variation leading to ACP documentation existing in multiple [...]

Background: Introduction : A Medical Orders for Scope of Treatment (MOST) form, adopted by the state of Texas in 2014, is similar to Physician Orders for Life Sustaining Treatment (POLST/MOLST) form in other states. It translates patient preferences for CPR, critical care, assisted nutrition, and transfer between healthcare facilities into a physician order set. Previous [...]

Background: Despite benefits of early Serious Illness Conversations (SICs), including increased satisfaction and earlier hospice referral, rates of SICs remain low. The primary aim of this study is to assess if standardized documentation of SICs increase following implementation of interventions for providers to have more of these conversations with patients admitted to a general medicine [...]

Background: The UCLA Department of Medicine (DOM) Rapid Mortality Review (RMR) is an innovative in-person, near real-time review of all deaths to capture the unique insight of the care providers into aspects of end-of-life care quality that otherwise go undocumented and unreported. The purpose of this study is to examine characteristics of mortality cases that [...]

Background: Serious Illness Conversations (SICs) lead to a better understanding of patient values and preferences, improved patient and family satisfaction, and other benefits. Prognostic awareness and early identification of patients who may benefit from an SIC remains a challenge. Epic’s Risk of Unplanned Readmission (Readmission Risk Score), a composite score (0-100) that includes clinical factors [...]

Background: Advance care planning (ACP) is recommended to improve compliance with patient end-of-life wishes and to ensure appropriate use of healthcare resources. However, most American adults have neither living wills nor advance directives. Hospital physicians play a critical role in discussing and executing advance care plans, and stronger doctor-patient relationships may help increase rates of [...]