Asking Older Adults With Impaired Cognition and Care Partners About Serious Illness Experiences Can Elicit Goals of Care During Advance Care Planning.

BackgroundSerious illness experiences, i.e. experiencing critical illness personally or through close ones, often influence end-of-life goals of care. Little is known about how older adults with cognitive impairment respond to serious illness experience questions during advance care planning (ACP).ObjectivesOur aim was to demonstrate the utility of serious illness experience questions as a strategy for eliciting goals of care during ACP among older adults with cognitive impairment and care partners.MethodsThematic analysis of 92 transcribed ACP conversations involving older adults ≥80 years old who screened positive for cognitive impairment and their care partner. Trained facilitators used a structured ACP conversation guide that probed serious illness experiences.ResultsParticipants often described multiple serious illness experiences influencing goals of care, which fell on a spectrum between longevity and comfort. Experiences involving negative clinician interactions provided opportunities for participants to emphasize longevity in their goals of care. Experiences involving severe disability or iatrogenic harm provided opportunities to emphasize comfort in their goals of care.ConclusionsOlder adults with cognitive impairment and their care partners were able to respond to serious illness experience questions, with responses eliciting a spectrum of goals of care. Integrating such questions into ACP for older adults with cognitive impairment may clarify goals of care and improve decision-making for patients and families.