Table 2 Qualitative coding framework, themes, and quantitative results
THEME n(%) | Total N = 206 | Documented in ACP Note N = 84 | Not Documented in ACP Note N = 122 | p-value |
|---|---|---|---|---|
Section 1: Documentation of Prognosis & Disease Stage Understanding | ||||
Assess illness understanding | 183 (89) | 76 (90) | 107 (88) | 0.54 |
Life expectancy | 46 (22) | 19 (23) | 27 (22) | 0.93 |
What will happen in the future | 21 (10) | 7 (8) | 14 (11) | 0.47 |
Section 2: Documentation of Decision Alternatives, including Broad Goals of Care & Treatment Options | ||||
Explore goals and values | 171 (83) | 76 (90) | 95 (78) | 0.02* |
Broad goals of care (includes longevity, function, comfort) & QoL | 141 (68) | 67 (80) | 74 (61) | < 0.01* |
Personal Goals (e.g., family, location/home, events) | 87 (42) | 36 (43) | 51 (42) | 0.88 |
Tradeoffs (including risks/benefits) | 58 (28) | 20 (24) | 38 (31) | 0.25 |
Explore patient treatment preferences | 201 (98) | 81 (96) | 120 (98) | 0.38 |
Hospice | 128 (62) | 52 (62) | 76 (62) | 0.96 |
Cancer treatment | 127 (62) | 48 (57) | 79 (65) | 0.27 |
Code status | 105 (51) | 64 (76) | 41 (34) | < 0.01* |
ICU/life support/machines | 79 (38) | 37 (44) | 42 (34) | 0.16 |
Surrogate decision making | 10 (5) | 7 (8) | 3 (2) | 0.05 |
Discuss uncertainty (medical) | 8 (4) | 3 (4) | 5 (4) | 0.85 |
Make recommendations/treatment no longer an option | 82 (40) | 34 (40) | 4 (39) | 0.87 |
Address emotional/spiritual needs | 31 (15) | 6 (7) | 27 (22) | < 0.01* |
Section 3: Documentation of Decision Making | ||||
Document a clear decision/plan | 170 (83) | 70 (83) | 100 (82) | 0.80 |
Document ongoing decision making process | 46 (22) | 24 (29) | 22 (18) | 0.07 |
Provide information about options with unclear next steps; no documentation of shared decision making | 8 (4) | 2 (2) | 6 (5) | 0.36 |