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Kidney Week

Abstract: FR-PO038

Perceived Value of Advance Care Planning Documents in the Electronic Health Record: A Qualitative Study of Chief Medical Information Officers, Clinicians, and Patients with CKD

Session Information

Category: Augmented Intelligence, Digital Health, and Data Science

  • 300 Augmented Intelligence, Digital Health, and Data Science

Authors

  • Kennefick, Kristen, Tufts University, Medford, Massachusetts, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Ladin, Keren, Tufts University, Medford, Massachusetts, United States

Group or Team Name

  • DART Team.
Background

Older adults with advanced chronic kidney disease (CKD) are at high risk for hospitalization, serious complications, cognitive decline, and death. Despite this, advance care planning (ACP) remains low among this population. Barriers to ACP completion and the impact of ACP availability in the electronic health record (EHR) are not well understood.

Methods

Qualitative study using semi-structured interviews (March 2022-March 2023) with purposively sampled patients (CKD stage 4-5 patients, age ≥50), chief medical information officers (CMIOs), and clinicians. Participants discussed EHR-related barriers and facilitators to ACP completion and accessibility. Audio recordings were transcribed verbatim and a thematic analysis was conducted.

Results

72 participants (29 clinicians, 11 CMIOs, 33 patients) completed interviews. Among clinician and CMIO participants, 33% were women and 43% were from the Northeast. Among patients, 36% were women, 39% identified as Black, and mean age was 70 ± 9 years. Four themes with subthemes emerged: 1) Challenges to ensuring patient autonomy (document ownership, evolving patient preferences, ensuring preferences are actionable); 2) Valuable ACP requires interoperability (lack of standardized ACP protocols, variable access across settings, limited infrastructure and incentives, policies for improving interoperability); 3) Complexity of timing (in-the-moment decision-making, clinical triggers for ACP, opportunities for automation and improved workflow); and 4) Consequences of inconsistent ACP protocols (discordant care, overconfidence that patient wishes are known).

Conclusion

The perceived value of ACP is negatively impacted by inconsistent accessibility of ACPs across settings. Recommendations for increasing the reliability of ACP at the time of need include encouraging patient ownership of ACP documents; ensuring revisions occur regularly and are reconciled in the EHR; institution-level training on storage and documentation of ACP in the EHR; employing available EHR tools such as trigger messages; and introducing financial incentives for sharing across institutions.

Funding

  • Private Foundation Support